title: Physicians criticizing physicians to patients.
abstract: BACKGROUND
  Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being.
  
  
  OBJECTIVE
  This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians.
  
  
  METHODS
  Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians.
  
  
  METHODS
  Twenty community-based oncologists and 19 family physicians had encounters with SPs.
  
  
  METHODS
  Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments.
  
  
  RESULTS
  Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient's previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians.
  
  
  CONCLUSIONS
  This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
authors.affiliation: Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA, Susanh2_mcdaniel@urmc.rochester.edu.
authors.forename: Susan H
authors.initials: SH
authors.lastname: McDaniel
authors.forename: Diane S
authors.initials: DS
authors.lastname: Morse
authors.forename: Shmuel
authors.initials: S
authors.lastname: Reis
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Edwardsen
authors.forename: Mary Gale
authors.initials: MG
authors.lastname: Gurnsey
authors.forename: Adam
authors.initials: A
authors.lastname: Taupin
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Griggs
authors.forename: Cleveland G
authors.initials: CG
authors.lastname: Shields
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D010348:Patient Care Team / Q000592:standards*; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D010817:Physician-Patient Relations; D010820:Physicians / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*