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Physicians Criticizing Physicians to Patients

ABSTRACT

BACKGROUND

Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being.

OBJECTIVE

This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians.

DESIGN

Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians.

PARTICIPANTS

Twenty community-based oncologists and 19 family physicians had encounters with SPs.

APPROACH

Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments.

KEY RESULTS

Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient’s previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians.

CONCLUSION

This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.

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Acknowledgements

Funding

The data collection for this study was funded by the US National Cancer Institute R21CA124913, Cleveland G Shields PhD, PI, and Jennifer J Griggs MD, Co-Investigator. Analysis and writing for Diane Morse MD was funded by United States National Institute of Mental Health T32 MH18911, PI Eric Caine, MD; National Institute on Drug Abuse 1K23DA031612-01A1; and the McGowan Charitable Fund, 524475.

Contributors

Thanks to Ronald Epstein MD and Richard Frankel PhD for their critiques and input on this manuscript.

Conflicts of Interest

The authors declare that they do not have any conflicts of interest.

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Correspondence to Susan H. McDaniel PhD.

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McDaniel, S.H., Morse, D.S., Reis, S. et al. Physicians Criticizing Physicians to Patients. J GEN INTERN MED 28, 1405–1409 (2013). https://doi.org/10.1007/s11606-013-2499-9

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  • DOI: https://doi.org/10.1007/s11606-013-2499-9

KEY WORDS

  • physician communication
  • teams
  • criticism
  • cancer