A recent research article in the Journal of General Internal Medicine, and the gap between its findings and the real world, helps point up the usefulness and limitations of research. The article, by Susan H. McDaniel, PhD, and coauthors, set out to determine how often doctors speak about their colleagues in supportive or critical ways.
Their method is one widely used in the field: simulated patients, actors, were prepared with lifelike stories about their feigned cases of advanced lung cancer complete with manufactured charts describing what previous doctors had done. The conversations they had with physicians (some oncologists, others family medicine practitioners) were recorded, transcribed, and analyzed; each statement by a physician about the care provided by other doctors was categorized as supportive, critical, or neutral.
The results were not altogether surprising, but I’ll let their abstract’s summary speak for itself (I edited it slightly):
Twelve of 42 comments (29%) were supportive, 28 (67%) as critical, and 2 (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.
As far as I can figure out, however, the article did not discuss what doctors should do in a very common circumstance: when their patients did receive treatment from another physician that they, the doctors, feel was incorrect. Last week, for example, I saw a patient who had been treated by some oncologists (they weren’t from Hopkins, which doesn’t mean this story couldn’t have applied to them). They had given her treatment without discussing with her the risks or benefits. She came to me bewildered and frustrated.
So what should I have done in that case? Made polite noises? Reflected the patient’s feelings? I did those as well. At some point, though, the patient’s intuitions should be verified and the truth called out: no, it is not okay to leave the patient’s wishes and preferences out of the equation, and all the more so when they are vulnerable, as cancer can make anyone.
Sure, tactfulness is key, and collegial relations with other providers can be maintained in such a circumstance, but identification of systematic missteps in care (such as leaving the patient out of a treatment discussion) is no vice. In fact, such honest talk is in the very service of professionalism.
How do you talk about your other doctors with your primary care provider?
Zackary Berger is an internal medicine physician. He blogs at his self-titled site, Zackary Sholem Berger, and is the author of Talking to Your Doctor: A Patient’s Guide to Communication in the Exam Room and Beyond.