I was recently, on two occasions, the recipient of poor care. Care provided by my colleagues. Care that was not good. Care that made me feel sad. Care that did not help me or my patients. First, I was yelled at by an angry son, who said I had not taken good care of his 89-year-old mother and had “almost killed her.” He told me that information came from the hospitalist, who had “saved her,” and unlike me, really did know what he was doing. Her son wanted me to know that his mother would have a “more competent” physician when she returned to the long-term care facility. That, and he wanted me to know he is considering “suing your ass.” I told him I was sorry his mother was ill and hoped she would fully recover. I did not apologize for the care I had provided her for six years, which I know has been excellent. This hospitalization was due to an acute decompensation of CHF, unpredictable and unpreventable. It still hurt,though, as it has over my many years in medicine, on those occasions my colleagues have chosen to speak ill of my care to patients and to families, almost always giving incorrect information, I should add. I call this the “It’s lucky you came to me in time “convention. Let’s get rid of it. It doesn’t help the patient, it doesn’t solve the problem, and it upsets families. It is not part of an effective care plan. So why do some physicians do it? I don’t have a good answer. Does it make them feel better? Smarter? More competent? I myself have done it only once, never again. When I was a first-year resident and knew everything, I criticized one of the private physicians at rounds for his care. My attending made me call him, and he explained his thinking and plan. It was most reasonable. Then he provided me with a good guideline I have always kept with me: Consider that every physician you encounter is at least a little smarter than you are. Assume they know what they are doing, even if you don’t understand it. Most of the time they will be right. When you don’t get it, ask. Do it collegially, and it will be received well. Perhaps working together you can find an even better intervention, That way, the patient will always be best served. And if you sincerely feel a physician has made a serious mistake or provided poor care, you should contact him or her directly. Go ahead, express your concerns. Be prepared, though, for a response that may well explain why the treatment provided was in fact correct, or at least was a reasonable option at the time. Then later last week my 82-year-old long-term care resident with stable BPH symptoms was admitted to the hospital with urinary retention and urosepsis. Investigating what had happened, I found that his neurologist had six weeks earlier stopped Flomax and Finasteride I previously had ordered with good response because she felt he was having postural hypotension. Had she called me, I would have declined her recommendation, with my thanks for asking me. Too much talking by one physician, poor judgment by another. Two unfortunate and avoidable results. What to do? I encourage you to give our colleagues the courtesy and the respect they deserve. Appreciate the care they provide, question professionally and politely when you must, don’t make changes without their input. Work together. Everyone wins, the patient most of all. And never assume you are the smartest person in the room. You almost never will be. Source
