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Throwing the doc under the bus: Undermining trust and the doctor-patient relationship

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Dr. Kevin Campbell Dr. Kevin Campbell
RALEIGH, N.C. -

We ALL try to do our very best for our patients.  Often the decisions we make have profound impacts on outcomes.  

Medicine is NOT always "cut and dry" and many times gut instinct and judgement calls must play a role in choosing therapies for patients (especially when made in the setting of best available data).  As it is in most professions, "Monday morning quarterbacking" frequently occurs in medicine as well.  It is much easier to make decisions and treatment choices when looking back on a case from the other side–it is much dustier in the trenches of an ongoing illness.

Today, in the New York Times, author Pauline Chen discusses the consequences that occur when doctors publicly (in front of other patients or colleagues) criticize another medical professional.  It is only human nature to want to present ourselves to our patients as the expert in a given area–the doctor with the best chance of making them better.  Unfortunately, some providers routinely make negative public comments about other physicians' abilities or treatment decisions.  Even though these comments may be accurate and well substantiated, these types of comments ultimately harm the patient and the healthcare system.  Certainly, many physicians see "protecting" patients from harm or substandard care as part of their job–rightly so–however, there are much better ways to accomplish this goal.

During training, even though much time is devoted to cultivating a culture of respect for and collaboration with colleagues from different specialties, incidences of "throwing {other doctors or teams} under the bus" can occur on a regular basis.  Fatigue and the pressures of training often play a role in the poor judgement associated with making derogatory comments.  In my experience in training these comments were often made between physicians of different specialties–such as internists vs. surgeons.  In training turf battles between specialties often deteriorated into negative commentary about the physicians or specialties in general.  These bad habits often translate into future lapses of judgement when in practice.  Instead of the sleep deprivation and military style training experienced by residents, pressures for increased productivity, increased documentation and higher volumes create the "mental fatigue" and frustration for the practicing physicians.  No physician is immune as we are all human–I myself have been guilty in the past of making negative comments about another physician who had a very high major complication rate in the Electrophysiology Lab.  Although my motivation for my comment was protecting patients from an incompetent surgeon, my course of action was flawed.  In the end, the physician was fired BUT, by making public comments concerning his abilities, I undermined the trust that patients have in their doctors.

It is essential that patients are able to trust their doctors to provide competent, compassionate care.  It is also essential that physicians stand up for their patients and speak up when they see care that it not up to standard.  However, physicians must utilize proper channels for addressing peer to peer related performance issues (such as medical staff QI committees, etc).  

Badmouthing colleagues reflects poorly on everyone involved and jeopardizes the doctor-patient relationship.  A recent study published in the Journal of General Internal Medicine explored the impact of doctors criticizing other doctors.  In the study the researchers found that critical comments were most often made about physicians in different specialties and resulted in higher levels of patient distrust in physicians in general.  It is very clear that we must do a better job of training physicians to work in a more collaborative way–constructive criticism (in the proper setting) can be beneficial to everyone.  However, publicly throwing a colleague "under the bus" is never the right answer.

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