Capsule Commentary on McDaniel et al., Physicians Criticizing
Physicians to Patients
Thomas W. McLean, MD
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Gen Intern Med
© Society of General Internal Medicine 2013
criticize other physicians to patients? This study by McDaniel et
al. suggests that they do, at a surprisingly high rate.1
This study covertly recorded conversations between
standardized patients (actors) and consenting physicians
(oncologists and family physicians), and then qualitatively
analyzed the content. The standardized patient portrayed a
middle-aged man who had been treated elsewhere for
advanced lung cancer and was getting established in a
new community. The investigators report that in 14 of 34
encounters (41 %), a total of 42 comments were made about
the care they received by a previous physician. Two-thirds
of those comments were critical, despite the fact that the
patient received appropriate care as currently defined by the
National Comprehensive Cancer Network. Importantly,
these critical comments were initiated by the physicians
and not the patients. Of the remaining comments, 29 %
were supportive, and 4 % were neutral.
Why is this important? When physicians criticize other
physicians, patient satisfaction and quality of care may be
adversely affected. The American Medical Association and
American College of Physicians consider such criticism as
disruptive and unprofessional.2,3Education and effective
training may help prevent this behavior. Creating a “culture
of respect” is important for improving communication,
safety, job satisfaction, and, ultimately, patient outcomes.4If
a physician has concerns about a patient’s previous care,
hysicians are taught to think critically and practice
evidence-based medicine. They read articles and review
speaking directly to the previous physician is usually the
This study is limited by the use of standardized patients, a
relatively small number of encounters in one community,
and a single clinical scenario. Nevertheless, the findings are
important and warrant follow-up. Future studies, potentially
with real patients, should study this phenomenon in larger
numbers and assess methods for reducing this behavior.
Of course there is room for disagreement between
physicians. Medicine is, after all, an art and not a science.
But there is no place in medicine for unprofessional or
disruptive behavior. This study is an important early
contribution in a respectful “conversation.”
Conflict of Interest: The authors declare that they do not have a
conflict of interest.
Corresponding Author: Thomas W. McLean, MD; Department of
Pediatrics, Wake Forest University School of Medicine, Medi-
cal Center Boulevard, Winston-Salem, NC 27157, USA
1. McDaniel SH, et al. Physicians criticizing physicians to patients. Journal
of General Internal Medicine. 2013. doi:10.1007/s11606-013-2499-9.
2. American Medical Association Opinion 9.045. Physicians with disruptive
behavior. 2000. Available at http://www.ama-assn.org/ama/pub/physician-
May 17, 2013.
3. Snyder L, et al. American College of Physicians Ethics Manual: sixth
edition. Annals of Internal Medicine. 2012;156:73–104.
4. Leape LL, et al. Perspective: a culture of respect, part 2: creating a
culture of respect. Acad Med. 2012;87:853–8.