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July 12, 2013

When doctors 'throw each other under the bus'

Daily Briefing

Despite sweeping efforts to create a "culture of respect" among medical professionals, new research suggests that doctors still are quick to criticize their colleagues in front of patients, author and surgeon Pauline Chen wrote this week in the New York Times' "Well" blog.

In 2002, the Institute of Medicine called for a "sweeping redesign of the entire health system" that would require better collaboration and cooperation among physicians. And Chen suggests that many groups took the call to heart, medical schools, regulatory agencies, health systems, and professional organizations reconceived the way they define and address professionalism.

However, a new study in the Journal of General Internal Medicine suggests that "old habits and responses die hard," Chen writes.

For the study, researchers trained three actors to portray patients with advanced lung cancer who had moved to a new community after being treated by another doctor. Armed with medical records written to reflect universally accepted care guidelines, the actors visited more than three dozen family physicians and cancer specialists.

Though the actors were not told to request an opinion about their previous care, the study found that 41% of the physicians offered their opinion without being asked. Of those:

  • 29% of comments were supportive of the previous physician;
  • 67% of comments were critical; and
  • 4% of comments were neutral.

"Doctors will throw each other under the bus," says lead author Susan McDaniel, adding, "I don't think they even realize the extent to which they do that or how it can affect the patients."

McDaniel notes that, in the moment, criticizing another doctor can seem like an effective way to establish 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,'" she explained. However, previous research has shown that shifting blame actually undermines patient trust and can compromise patient outcomes, Chen notes.

Learning respect

McDaniel teaches a physician coaching program at the University of Rochester Medical Center that aims to foster respect among colleagues. So far, she and her team have worked with 150 doctors, observing them with patients and colleagues and offering feedback and support, particularly during stressful situations. 

Currently, "[t]here's a lot of attention focused on the patient experience, but I think we need to work on improving the clinician experience as well," McDaniel told Chen (Chen, "Well," New York Times, 7/11; McDaniel et al., Journal of General Internal Medicine, May 2013 [subscription required]).

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