Asking a doctor for their opinion on another physician

If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?

Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.

But how do you know who’s on their game and who’s falling down on the job? It’s tricky for patients because they often don’t know enough about medicine practice to judge competency. This makes putting your body under the care of any doctor scary.

So scary, in fact, that an entire malpractice industry has sprung up to reassure patients that incompetent doctors will be severely punished. Unfortunately malpractice usually ends up a witch hunt that can burn good doctors at the stake and let bad ones go

Wouldn’t it be nice if you had someone who understands medicine who could tip you off on the bad ones? Yes, but it’s a complicated thing to ask your doc if another doc is incompetent or not.

Judge not, lest you be judged

Competence is not always as black and white as you might think. There is a good bit of gray and ambiguity involved. The real world practice of medicine involves a lot of educated guessing and trial and error. Even the best doctors occasionally make mistakes or use unorthodox treatments.

The real dangerous doctors are the ones that recklessly disregard patient safety and don’t even care about doing things right. And yes, unfortunately there are lots of doctors like this.

Incompetence may be common, but it is hard to prove. Doctor D occasionally sees signs of suspected incompetence in patients that have been treated by other docs. An incorrect diagnosis or an unorthodox treatment that seems way out of the expected margin of error and puts a patient at risk.

But these clues in the crime can be misleading. Sometimes Doctor D will see something and say to himself, “Self, what this doctor is doing makes no sense. I wonder if he is incompetent?” Later I met the doc only to find that he had an excellent reasoning for what he did, and was obviously acting in his patient’s best interest.

The medical gestapo

But there are some doctors that are all too happy to accuse their colleagues of incompetence. These docs believe there is only ONE competent way to practice medicine, and it is the way THEY practice.

These doctors want to be the to secret police who keep medicine in line. They are typically jerks with a massive god-complex. They gleefully tell every patient who will listen which doctors they think suck.

Doctor D has had encounters with the medical gestapo. They shoot first and ask questions later. They see the world in black and white. There is no gray area for them.

“Doctor D you didn’t follow the protocol! Are you thinking for yourself? Are you adjusting the protocol for individual patient’s situations? Off to the firing squad!”

Dealing with Dr. Danger

Witch hunts both from within and without medicine have soiled the names of a lot of good doctors. So Doctor D is always careful about fingering another doctor as a dangerous doc, even when he has his suspicions.

I currently know a doc who I am about 70% certain is a walking public health threat. I’ve seen a pattern of “WTF?!” medical decisions that make me highly suspicious that this dude either doesn’t know what he’s doing or doesn’t care.

How certain do I need to before turn Dr. Danger over to be burned at the stake? Well 100% actually.

I’ve been a target of the Medical Gestapo myself, and I know how damaging misguided doctor purges can be. I’m not blowing the whistle on Dr. Danger unless I know beyond a shadow of a doubt that he’s really what I think he is.

I’ve only been 100% certain one time before and that time I blew the whistle as loud as I could.

Subtle warnings

Although I’m not absolutely certain he’s incompetent, I wouldn’t want any of my family seeing Dr. Danger. It would be too much of a risk!

I can’t flat-out denounce him publicly, but I do want to steer patients away from the danger I suspect.

This is where subtlety comes in handy:

I might say “Dr. Danger does some really unorthodox things.” Or I might just fail to praise him, while my facial frown indicates I might not be totally cool with Dr. Danger. Or I could just change the subject and suggest you see Dr. Awesome instead.

This is how we doctors subtly steer you away from potential danger.

But you have to read between the lines, because if you flat out ask, “So Doctor D are implying you think Dr. Danger is totally incompetent and has no business practicing medicine?” Doctor D will smile and say, “Oh no, Dr. Danger is a delightful person! You have totally misunderstood me!” Then D will give you a wink.

Doctor D puts the B in subtle!

“Doctor D” is a physician who blogs at Ask An MD.

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  • http://secondbasedispatch.com Jackie Fox

    Interesting! I was talking to a nurse about this after one of my surgeries for breast cancer because my nurses uniformly told me how great my doctors are. One of them told me I “hit the trifecta” with my family doc, general surgeon and plastic surgeon. So I asked this nurse what you do when a doc isn’t respected or someone you wouldn’t go to yourself, and she said the same thing you did about subtlety. She’ll sometimes say, “Oh Dr. So and So also does that” or “Dr. So and So is supposed to be really good at that” and hope the patient can read between the lines.

    Thank you. We appreciate you warning us as best you can. I’ll remember to listen closely if (when) I’m starting over with new doctors one day.

  • http://drpullen.com medical blog

    The suBtle answers are best almost all of the time. Also beware the new patient who has seen numerous other physicians who were all horrible incompetent idiots but now you are totally wonderful and incredibly bright and insightful. In a few months you’ll be on their list of the former when they trash you to their next physician.

  • http://www.aprematureejaculationtreatment.com Jackie Fox

    Interesting! I was talking to a nurse about this after one of my surgeries for breast cancer because my nurses uniformly told me how great my doctors are. One of them told me I “hit the trifecta” with my family doc, general surgeon and plastic surgeon. So I asked this nurse what you do when a doc isn’t respected or someone you wouldn’t go to yourself, and she said the same thing you did about subtlety. She’ll sometimes say, “Oh Dr. So and So also does that” or “Dr. So and So is supposed to be really good at that” and hope the patient can read between the lines.

    Thank you. We appreciate you warning us as best you can. I’ll remember to listen closely if (when) I’m starting over with new doctors one day.

    I FORGOT TO SAY that I really love following your posts Dr. Kevin. You always have some insightful advice for people and it’s nice to see this.

  • Anon

    I was finally diagnosed with a rare metabolic disease after more than 15 years of doctor shopping. I never described my former doctors as “horrible incompetent idiots”. However, I’ve noticed many physicians heed the warning to “beware the new patient who has seen numerous other physicians”, no matter how the patient talks about them.

    • Anon

      Sorry, this was a reply to medical blog.

  • Dr Chris

    This is such a hard one. But I think changing the subject, or , you know, I think Dr Blop would be such a good fit for you.You’ll love his bedside manner.
    But I also might say, I’m sorry you had such a hard time wit Dr Greeblebox, but she’s such a good MD, I don’t know what happened (and I will probably call to find out the other side of the story), rather than recommend the suggested change.
    But again, watch the facial expression….

  • soloFP

    I find that nurses give some of the best recommendations for new patients to my practice. The nurses actually see how you treat the patients and interact directly with many doctors. Often doctor recommendations to a specific doctor is simply the doctor’s golfing or tennis country club buddy who may be nice to other doctors but a bear to deal with when being around patients and nurses.

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