Why Does Every System Blame Another Department First?

When in doubt, blame the other department.

Whether it’s the ED pointing fingers at internal medicine, surgery frowning at radiology, or primary care feeling sidelined by specialty clinics—blame has almost become its own method of referral in modern healthcare.

But why is this behavior so consistent across hospitals worldwide? Why does nearly every healthcare system—regardless of geography, budget, or hierarchy—have this reflex to fault “the other guys” when things go sideways?

This article dives deep into the culture of departmental blame—from the psychological mechanisms fueling it to the very real effects on patient care—and proposes tangible actions that physicians, students, and administrators can take to interrupt the cycle.

Blame Culture in Medicine: It’s Not Just About Ego
Let’s be clear—interdepartmental blame is not always rooted in hostility. It’s often an automatic reaction, a survival response embedded in high-stress, high-stakes environments. Yet over time, this defensive habit creates silos, builds distrust, and fractures the continuity of care.

It gradually replaces curiosity and accountability with suspicion and frustration.

Common Scenarios You’ve Definitely Heard Before:
“Radiology didn’t interpret the scan properly.”

“The ED dumped the patient on the ward too early.”

“Surgery delayed the discharge for no reason.”

“That’s primary care’s responsibility, not ours.”

What’s missing from all of these statements? A pause to ask, “What role did we play in this situation?”

Why Is Blaming So Common Across Departments?
1. Siloed Structures and Hierarchies
Hospitals are traditionally structured around distinct departmental silos—each with separate leadership, systems, and identities. While this might serve logistical and administrative efficiency, it limits interdepartmental understanding.

When an issue arises, it’s psychologically simpler to fault another silo rather than question the design of the whole system.

2. Fear of Legal Repercussions
In today’s climate of defensive medicine, blame becomes a subconscious legal defense. Assigning fault elsewhere—whether it’s justified or not—helps individuals psychologically distance themselves from liability.

The result? More documentation, more finger-pointing, and less ownership of the shared patient journey.

3. Communication Barriers
Hospital communication is often reactive rather than proactive. Trying to reach a specialist may involve paging systems, assistant filters, missed callbacks, or unclear messaging chains.

When direct, real-time conversations are rare, people fill in the blanks with assumptions. And assumptions breed mistrust.

4. Absence of Feedback Loops
When departments don’t debrief together after an adverse event or complex case, they miss the opportunity to reflect and grow. Without structured feedback, misinterpretations become institutional beliefs.

The blame becomes fossilized into the system.

5. Burnout and Workload
An overworked, emotionally drained clinician is more likely to reach for blame than to investigate a situation in depth. When cognitive and emotional resources are depleted, empathy falters—and so does teamwork.

The ability to say, “Maybe they’re just as overwhelmed” disappears.

Who Gets Blamed the Most (and Why)?
✅ Emergency Departments
Accusation: Rushed admissions or incomplete initial evaluations.
Reality: EDs often operate under immense time pressure, with sparse data and unpredictable case surges.

✅ Radiology
Accusation: Missed findings or “non-urgent” reads.
Reality: Radiologists manage high case volumes and often work with limited clinical context.

✅ Internal Medicine
Accusation: Slow to discharge, overly cautious in acute scenarios.
Reality: IM physicians manage intricate multi-morbidity, balancing risks and systemic constraints.

✅ Primary Care
Accusation: Poor referrals or missed diagnoses.
Reality: They manage broad-spectrum care with minimal time and continuity demands.

✅ Nurses
Accusation: Delayed escalation or “not informing the doctor.”
Reality: Nurses are often under-resourced and heavily protocol-bound.

Ultimately, every team is an easy target. Yet, systemic contributors remain unexamined.

The Psychology Behind the Blame Game
Cognitive Biases at Work
Fundamental Attribution Error:
We interpret others’ mistakes as character flaws (“they’re careless”) but our own as situational (“we were short-staffed”).

In-group/Out-group Bias:
We see our own department as hardworking and virtuous, while others appear sloppy or detached.

Availability Heuristic:
One bad experience with a department lingers and colors every future interaction with that team.

Tribalism and Social Identity
Departments become their own subcultures—each with distinct routines, communication styles, and values. This strengthens internal bonding but also creates “us vs. them” mindsets.

The stronger the department identity, the harder it becomes to bridge across disciplines.

Real Consequences for Patient Care
Delayed Diagnoses
When collaboration stalls due to blame, investigations are delayed, handovers are half-hearted, and patients fall through the cracks.

Poor Quality Handover
A toxic interdepartmental relationship leads to minimal, even passive-aggressive handovers. Important details are withheld or vaguely delivered.

The receiving team ends up starting from scratch, wasting time and risking safety.

Medical Errors
Blame culture disrupts communication—a leading cause of adverse events in hospitals. Information withheld or misinterpreted in haste can cost lives.

Moral Injury
Clinicians who feel unfairly blamed—especially when trying their best under challenging conditions—may suffer burnout, detachment, or even exit medicine altogether.

Training the Blame Reflex Starts Early
Sadly, the habit begins in medical school. Informal talk among students and instructors can frame departments in oversimplified, negative stereotypes.

“Surgery is cutthroat.”
“Psych doesn’t know how to manage real patients.”
“ED is chaos incarnate.”

Before students even rotate through these departments, they’ve been conditioned to expect dysfunction—and to blame.

If we’re serious about fixing interdepartmental culture, we need to start with how we teach. Respect and collaboration must be modeled early—not just knowledge or procedural skill.

How Can We Fix It? Actionable Solutions
1. Shared Morbidity and Mortality Rounds
Make M&M sessions multidisciplinary. Instead of using them to assign guilt, structure them to foster shared learning and systems improvement.

2. Cross-Departmental Shadowing
Allow trainees and staff to spend a day in another department. It builds empathy and dismantles misconceptions. Perspective often changes when you walk a mile in someone else’s clogs.

3. Standardized Handover Tools
Adopting structured communication methods like SBAR (Situation, Background, Assessment, Recommendation) minimizes ambiguity and finger-pointing.

4. Multidisciplinary Debriefs
After high-stakes cases or adverse events, gather the full care team—nurses, physicians, pharmacists, techs, and admin—for an open conversation. This helps surface blind spots and builds relational trust.

5. Incentivize Teamwork
Tie a portion of performance reviews and career advancement to collaborative behavior—not just volume metrics or individual KPIs.

When the system rewards teamwork, culture shifts.

6. Normalize Accountability—Without Shame
Accountability isn’t blame. It’s about recognizing a missed step and working toward prevention. But this only works in a psychologically safe space—one where admitting mistakes is a sign of maturity, not incompetence.

A Thought for Leaders and Administrators
If departments regularly blame one another, this isn’t merely a cultural issue—it’s a structural failure.

Healthcare leaders must invest in team dynamics, not just high-tech equipment. Joint training programs, shared workspace designs, conflict resolution coaching, and cultural audits are as critical to patient care as any imaging suite.

Because patients don’t get treated by departments—they get treated by systems.

And systems should function in harmony.

What Doctors Can Do Right Now
Stop perpetuating blame in front of trainees. Every time you dismiss another team as “useless,” you’re sowing seeds of the next generation’s bias.

Instead:

• Ask: “What might that team be going through right now?”
  
  
• Refer to individuals by name, not by department. It’s easier to understand and empathize with “Dr. Aziz from radiology” than “Radiology.”
  
  
• Intervene when unfair blame is cast. Redirect conversations toward shared solutions.
  
  
• Reflect: Did I do everything possible to communicate effectively and close the loop?
  

Conclusion: The Blame Stops Here
The impulse to blame another department is understandable—but it’s also preventable. It’s not just a reflex born of pressure. It’s a pattern, woven into how we train, communicate, and function.

But medicine is evolving.

If we’re going to build systems that are more humane, more effective, and safer for everyone—then we must replace blame with collaboration. Instead of asking, “Why didn’t they…?” let’s start asking, “What can we do—together?”

Because the patient in that bed doesn’t care who dropped the ball.

They just want us to pass it better next time.