"Jousting" is the unfortunate practice of one health care professional making derogatory comments about another provider’s care, either to the patient, or in the chart, and without having reviewed all the pertinent records, or discussing his concerns with the previous physician. We have often seen jousting as the cause of medical litigation, but until recently, jousting had never been studied. A 2013 article in the Journal of General Internal Medicine[i] shed light on this hitherto known but underappreciated practice.
Researchers from Rochester, Purdue, and Michigan wanted to know how physicians talked about other physicians to seriously ill patients. They evaluated this by enlisting standardized patients (SPs) to portray middle-aged men with advanced lung cancer. The medical record was constructed by a medical oncologist and reflected standard of practice care.
The SPs visited family medicine and oncology physicians and the visits were secretly recorded. The SPs presented for a first visit without the physicians’ knowledge of the study. The SPs were not to ask opinions about their previous care and previous physicians. The transcripts of these visits were analyzed and divided into neutral, supportive, or critical. Of the 34 encounters, 41 percent contained comments about prior care. Within a total of 42 comments, 12 were supportive, 28 were critical, and two were neutral.
One of the interactions went like this:
“So he radiated your ribs not your…,” said Dr. 25.
“Yeah,” said the SP.
“That guy’s an idiot,” said Dr. 25.
Hindsight is 20/20. Find out why, when doctors criticize other doctors, it is harmful to you, your peers and, most importantly, your patient.