Docs vs Docs: No One Wins

I’ve had the privilege of working with some world-renowned, extremely talented doctors and surgeons. Patients often come to these providers when they’ve failed treatments, or if they’ve received recommendations and are unsure which treatment may be best for them. Unfortunately, the providers often find their patients’ previous treatment lacking. They ridicule the decisions of other doctors (sometimes even in front of the patient).

Why do doctors attack each other? Their goal is ultimately the same – to treat and/or cure their patients. If two doctors see the same patient for the same problem, there are bound to be differences in approached. Some physicians may prefer certain times of imaging over others. Some physicians may advocate for naturopathic or less invasive treatments to start, whereas some physicians may be more aggressive.

In my experience, primary care physicians (PCPs) receive the brunt of physician-to-physician criticism. The PCP is the jack of all trades, master of none. They are the first-line for their patients. They have a broad understanding of most problems, start with certain treatments, then refer to specialists. Specialists often roll their eyes when patients come in with unnecessary imaging or testing ordered by a PCP. But how is a PCP supposed to know that a spine surgeon prefers MRIs to CTs?

This criticism is not only limited to PCPs. My mentor has a habit of criticizing specialists in the same field of being overly aggressive or performing unnecessary procedures in order to receive additional compensation (which should be considered fraud). As a result, I’m suspicious of many of his colleagues. I question the treatments and decisions made by other specialists.  I may disagree with their decisions, but I wasn’t there to understand why the physician made that decision. In addition, I’m not a physician. I can’t understand their decisions because I am not a trained physician. I’m afraid that this suspicion could affect my ability and willingness to learn from other doctors.

I believe this animosity arises in part from the competition started in medical school. Pre-meds compete for the best grades, the best scores, and the best schools. When we get into medical school, we battle for the best rankings, the best opportunities. Then we compete to match. In residency we strive to out do each other to get better fellowships, better pay, better attending positions. Those attending physicians compete for patients. Throughout the entire journey, there is a strong focus on competition over collaboration.

This approach has been evolving over time as medical schools recognize the cut-throat environment they create. The older generations of physicians, however, do not have the benefit of this approach. What’s more is they teach their residents and fellows to treat their fellow doctors with suspicion.

It is important to address incompetency or intentionally endangering patients. If the decision of a physician intentionally harms a patient, it needs to be addressed through the appropriate channels. My primary concern is not this, but doctors mocking their colleagues because it is not how they would prefer to treat their patient.

What these doctors fail to recognize is that treatments are an agreement between patient and provider. A doctor analyzed a patient’s position, offered options to the patient, and the patient made a joint decision with their doctor. With this arrogance, we create distrust in the relationships with patients. We also erode the trust that another doctor has established with a patient. In the end, both doctors lose. Neither doctor communicates with the other, the patient becomes wary, and treatment may get delayed while the patient considers other options or another opinion.

How do we address this issue? It’s not as easy as accepting differences in treatment approaches. It is understandable to be frustrated by lack of proper testing or treatment. Doctors and patients may feel like they are starting over, which can frustrate the patient as well. I have a few ideas about how to treat this issue with patients.

1) Don’t scoff or mock a doctor in front of the patient.

Referring to someone’s doctor as an “idiot” or “untrained” is rude in general. It also makes you seem arrogant. There’s no need to take out your frustration in front of the patient – it’s unprofessional.

2) Remember your source.

The information provided to you is subjective. Patients can get confused. Records may indicate the exact opposite of what the patient is telling you. What you may mistake for the provider’s problem may just be a misunderstanding.

3) Try to look on the bright side.

Has the patient had testing that you needed? Is there extra imaging that rules out a diagnosis? It’s unfortunate that the patient underwent so much testing, but it saves you time and establishes a greater picture of your patient’s health.

4) Communicate with the provider, if needed.

You’re seeing a patient for an issue. They tell you another provider has ordered a battery of tests. You disagree with the need for some (if not all) of these tests. You tell the patient you don’t find them necessary. Now the patient is confused. They trust the doctor that ordered them, but they also trust your judgment. Speak with the provider, agree on a plan of action, then convey that plan to the patient.

5) Explain your treatment plan to the patient.

The patient has seen a physician with a different plan of treatment. Without belittling the patient or their provider, explain why you’re taking a different approach. The patient needs to understand what’s happening and why. They may be happy to avoid expensive or invasive testing.

Have you heard providers disparage other providers? Do you engage in the negativity? Are my suggestions naive? Comment with your thoughts!

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