[SIGH/FROWN/ROLLING EYES/SHAKING OF HEAD DISAPPROVINGLY…] “Oh dear, you know your previous doctor should never have allowed things to get this bad. Why weren’t you referred to me sooner? What on earth were they thinking when they prescribed you this medication? They probably didn’t even send you for an x-ray. Did they even go to medical school?”
1. Clarify the term ‘medical jousting’
2. Explore how doctors might unfairly criticise one another
2. Reflect on how we can deliver justified constructive criticism to one another
Medical jousting is the uninformed criticism of a healthcare colleague. The scope of jousting can vary widely:
1. Direct verbal 🗣️ – Comments such as “you should take legal action against that doctor”.
2. Indirect verbal 🗣️ – For example, “that isn’t what I would have done”.
3. Body language 😲 – Signals such as a look of surprise or horror when a patient mentions something about their previous care.
4. Written in the patient record 📝 – Entries in the medical records such as “previous doctor should have asked for advice”.
5. Written outside the patient record 📱- This includes social media, doctor review websites and messaging services, for example “Doctor X was a moron at med school and remains a moron judging on what they did to Patient Z”. This has the added bonus of being open to public view and unsecure in terms of patient confidentiality.
What other phrases or signals might be used in jousting?
Have you ever been the recipient of jousting and how did it feel?
Have you ever jousted a colleague and why?
It appears that jousting might be more common than you might think. One small study found that when comments were made about another doctor during a patient consultation, 67% of them were critical verses 29% which were supportive (4% were considered neutral). Criticism about colleagues in another speciality was particularly noted (I’ve touched on the issue of understanding between primary and secondary care before).
Is it easier to joust across medical specialities?
Is it easier to joust between primary and secondary care?
What factors facilitate jousting?
I’d like to hope that jousting, when it does occur, is usually unintentional. However, it can also be intentional. In high stakes or stressful clinical situations, jousting may form part of a defensive strategy to divert blame should something go wrong. It also appears to be more common with privatised healthcare systems where colleagues can become competitors. Negatively commenting about a competing doctors decisions (or lack of them) might be seen as a way to bolster one’s own business.
When taking over the care of a patient, how can you be confident that you are aware of all the factors the previous doctor had to consider before they made a management decision?
Can you think of an example where doctors can justifiably differ in their approach to patient care?
Are patient recollection of clinical encounters always accurate?
It is reported that 40-80% of medical information provided by healthcare practitioners is forgotten immediately by patients.
Jousting can lead to a loss of confidence and trust in healthcare professionals. Reputations are tarnished and it risks litigation for all parties involved (along with the associated stress and financial implications). This isn’t to say that bad healthcare should be concealed. Many doctors have an obligation to highlight when things have gone wrong. Jousting, however, is different since the criticism is unsupported by the full facts.
Do you write your suspicions of previous poor care in the patient record?
Could this have future legal ramifications for both you and other doctors involved?
Might some patients seek second opinions in order to gather evidence for percieved previous malpractice?
I’m uncertain of where the term ‘medical jousting’ originated. It does seem to conjure up thoughts of knights, castles and of courtly life. This seems far removed from the doctors, hospitals and medical wrangling that we’re discussing. The term ‘jousting’ means to engage in battle and is derived from the Old French ‘jouster’ (bring together) and Latin ‘juxta’ (near). However, it can also mean to compete closely for superiority.
Using words (instead of lances) to attack colleagues can be interpreted as way of achieving superiority in the eyes of the patient. The recipient of the attack or criticism may become adopt a defensive posture. If medical jousting becomes normalised, any critical feedback, justified or not, is received with hostility. This has implications on how doctors think, learn and respond to challenges. This siege mentality will affect teamwork and patient care, especially in an environment where staff are already overworked.
So how can colleagues try and get the full facts of a patient case before they make assumptions about poor care?
1. Transfer of the previous patient records 📖 – this can take time and may not accurately convey all the issues surrounding a clinical situation
2. Talking to the previous doctor 💬 – a face-to-face conversation is an option if you physically work together, but is not so easy if you work in different environments. A phone call might work if you find a mutually convenient time. In addition, a call coming out of the blue from an unknown doctor may seem peculiar unless the conversation is framed correctly.
3. A letter or email to the previous doctor ✉️ – this may come across as quite formal or threatening, perhaps interpreted as a prerequisite to litigation in healthcare systems where correspondence like this is not normal practice.
In fact, there appear to few viable options for doctors to gather timely informal insights about specific cases from colleagues, especially colleagues who they have never encountered before or who work in a different speciality.
Medical jousting is quite a nasty phenomenon and nearly not as courtly as it first sounds. It can taken many forms and represents a failure of communication. It is also a euphemism, a noble sounding term for a very ignoble act. They really should make a jousting emoji.
Physicians criticizing physicians to patients
Patients’ memory for medical information