Badmouthing other doctors from NYTimes

A fascinating piece from the NY Times ( ) indicates that many physicians are quick to disparage other physicians, even when the care that was provided was appropriate. Below is an excerpt:

Over the last decade, few issues have garnered as much interest among health care experts as disrespectful behavior among doctors. While sociologists have devoted careers to researching the topic, it wasn’t until the 1990s that the medical profession itself began to take serious note.

Spurred on by the increasing complexity of medicine, concerns about safety and patient satisfaction and an ever-growing urgency to contain costs, the Institute of Medicine convened a national panel of health care experts to discuss “the chasm” between what could be and what was actually being done for patients. In 2002, they published an ambitious report that called for a “sweeping redesign of the entire health system.” Realizing that vision, said the panel, would require, among other changes, better collaboration and cooperation among physicians and the creation of a “culture of respect.”

Medical schools, regulatory agencies, professional organizations and entire health care systems responded to this cri de coeur. Official definitions of professionalism were rewritten to incorporate the concepts of teamwork and shared responsibility. Schools added mandatory coursework on thewhys and hows of working in a team. And licensing and accreditation boards began asking for evidence that doctors could not only lead, but that they also knew how to work as part of a team.

But this new study reveals that old habits and responses die hard.

Researchers trained three actors to portray “standardized patients” with advanced lung cancer who had recently moved to town after being treated by another doctor and who remained unsure about their diagnosis or prognosis. The actors, carrying medical records written to reflect only universally accepted guidelines of care, made a total of nearly three dozen office visits to various family physicians and cancer specialists working in the community.

The actors were not told to elicit the doctors’ opinions about their previous care; but after analyzing transcripts from each office visit, the researchers found that in 40 percent of the consultations, doctors went ahead and spontaneously offered their opinion anyway. A tiny percentage of these comments were neutral; a third were supportive. The vast majority, however, were unabashedly critical, with the doctors’ comments ranging from “Hell, you don’t want to trust doctors,” to “This guy’s an idiot!”

“Doctors will throw each other under the bus,” said Susan H. McDaniel, lead author of the study and a professor of psychiatry and family medicine at the University of Rochester Medical Center. “I don’t think they even realize the extent to which they do that or how it can affect patients.”

Probably, added Dr. McDaniel, most of the comments were unintentional. Faced with a constant pressure to cut costs, increase productivity and keep patients happy, plus the additional difficulty in this case of discussing prognosis with a terminal cancer patient, many of the doctors no doubt experienced significant levels of stress. In the moment, criticizing another physician to a patient might have felt like an effective way to fortify their own credentials and build up the patient’s trust.

“There is probably something reassuring in saying, ‘Boy, your doctor didn’t do a good job and now I’m going to take care of you,’” Dr. McDaniel noted. “But those kinds of comments are bad for the patient.”