Doctors, Don't Throw One Another Under the Bus

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Commentary — December 2016

Tex Med. 2012;112(12):11-12.

By Jeremy Gabrysch, MD

Here is just a sampling of things I hear from my patients all the time:   

  • "I went to the ER, and they said my wrist might be broken, even though the x-ray was negative. The orthopedic doctor said that was ridiculous."
  • "We went to the urgent care over the weekend, and my daughter was put on antibiotics for an ear infection. When I saw the primary care doctor, he said she doesn't need antibiotics and that the doctor was being overly cautious."
  • "My mother had this dizzy spell, and the doctor was worried that it was a mini-stroke. The doctor we saw in follow-up said there's no possible way this was a mini-stroke. I don't know whom to believe. Did that first doctor know what she was doing?"  

Comments like these are indicative of a disturbing trend: For some reason, many doctors feel compelled to add on to, embellish, or otherwise totally repudiate the findings of another doctor who had previously treated the same patient. There is a bit of one-upmanship evident in medicine right now, and it is tarnishing the good name of the physician's role. This behavior is casting a great deal of doubt and mistrust among patients in a time when they have unprecedented access to information that may or may not be relevant to a diagnosis and subsequent treatment.

It's natural to want to make our mark, add value, and show the patient we are worthy of their time and money, but at what point does that inhibit a doctor's ability to provide patients with accurate diagnoses and treatment, gaining his or her trust?  

A friend of mine is the medical director for an emergency department. He frequently fields complaints from patients who say their primary doctor or a specialist contradicts what was done in the emergency room. But most of the time, the care provided in the emergency room was completely appropriate, given the information available at the time and the circumstances surrounding the visit. Why do some doctors feel the need to demean another's work?

The digital age and the internet have brought this to a frenzied height. I recently evaluated a 10-month-old child with a fever who had vomited twice. The father sat in a chair on his smartphone googling possible causes while I was evaluating the child. "Could it be this one, bowel obstruction?" he asked. He goes on to prompt me with diagnoses that he is finding on his web search. "Gastroenteritis, appendicitis?"

I love that patients have more information than ever before. I really do. I want people to know what a bowel obstruction is so when I explain that it isn't that, they will understand. But it has reached a point where many patients don't really think the doctor knows much more than they do, or at least much more than what is available to them on the internet. And when doctors criticize what another doctor did, this only compounds the erosion of the public's trust.

When I got married, a wise man who had been married for many decades told me, "Always give the benefit of the doubt." That advice has served well in my marriage, and it would serve us well as doctors. We need to give each other the benefit of the doubt. 

If the doctor in the urgent care thought a child needed antibiotics and you don't, try to contain your ire. If you don't think an occult scaphoid fracture was a concern in that patient with wrist pain, don't dismiss it as ridiculous that another physician did. Support one another. 

If there's gross negligence, of course that needs to be addressed, but that's not the case most of the time. Usually, a physician is doing the best he or she can with the information available, often under different circumstances than the ones in which you find yourself during a follow-up or consult. Supporting one another will pay dividends in restoring the public's trust in the local doctor.

Jeremy Gabrysch, MD, is the founder and chief executive officer of Remedy Urgent Care, an Austin-based mobile urgent care service. He is an emergency medicine physician who trained at The University of Texas Southwestern Medical School. 

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