In recent years, there has been a push to teach professionalism to medical students. This is in part a response to a perceived decrease in respect for physicians by the general public. Much of the emphasis on teaching professionalism has been on treating patients with respect and placing the needs of the patient over our own needs. I support this effort but would like to emphasize a different aspect of professionalism that seems to get less attention: the relationship we have with our colleagues.
Doing Our Duty
The duty of professionalism arises because medicine is a profession—we profess an oath to become members, we perform a task held in high regard by the public, and we promise to self-regulate. Given that this is the nature of medicine, we can easily now say something about how we must treat our colleagues in order to best uphold our oath and to best maintain the reputation of our vocation.
For Aristotle, a virtue is often found as the mean between two excesses that are vices. This model is appropriate for determining the virtuous, professional way we should treat our colleagues: show respect, but do not protect incompetence or misbehavior. Put another way, we have dual duties to respect our colleagues but also to protect our patients. When these duties conflict, our patients must come first. However, failing to respect our colleagues has negative effects on both the status of our profession and on patient care itself.
Egos, Judgment, and Second Opinions
One aspect of respecting our colleagues that I often find lacking is giving the benefit of doubt to our colleagues, especially when we have only a patient report or incomplete information. It is tempting to pass judgment on another doctor, particularly when a patient seeks a second opinion. Attacking the other physician who is not there to defend herself or himself is an easy way to gain a competitive advantage over our colleague/competitor.
Yet, in my experience, when I have the records and can see my colleagues’ thinking, I find myself affirming their decisions more often than challenging their conclusions. Even if I differ in the way I would handle the case, unless the chart shows real incompetence (and I cannot even recall an example of this), it is better to explain to the patient both sides and describe it as a difference in views, rather than a choice between a right and wrong therapy.
The psychological temptation to tear down another to build ourselves up must be resisted because the effect, from the patient perspective, is not simply to question the other physician but rather to question the profession of medicine itself. Because patients have no way to discern the truth without assistance, they are left wondering who to believe and left questioning the general integrity of physicians. We must choose language that does not criticize the other physician and that affirms that the recommendation offered is reasonable. If you disagree, offer an alternative based upon your judgment or experience.