Patient Care Comes Before Physician Friendships

When I was a resident, there were two attendings that terrified us. One was a hematologist from New Zealand if I remember correctly, probably in his late 50s at the time. The other was an infectious disease specialist. I don't think she was even five feet tall, probably in her late 40s or early 50s. They both scared the bejesus out of us. Why? They demanded if not perfection, then something very close to it. If we called them about a patient, we better have all the pertinent information ready and our presentations precise and to the point. If not, they were not sparing in expressing their disdain for our ineptitude.

As a new attending, one of my colleagues was likewise unforgiving of incompetence. If you were seeing one of her patients, or if you had to ask her to see one of yours, you better cross your t's and dot your i's, or she was sure to point out your shortcomings to you. Students, residents, other attendings, even the department chief, were afraid of her.

And yet, we respect them. Why? Because they knew their stuff. They were excellent clinicians, and they expected the same level of excellence from those around them. If you had the audacity to allow other humans to put their lives in your hands, then you had better be prepared to provide them with the best care possible. It wasn't too hard to accept the harsh criticism when we were the underlings. I had never really thought of how peers might feel about it.

Until recently, that is. Being trained under such circumstances has also made me a stickler for quality care. I don't claim to be perfect, but I have very little tolerance for what I perceive as improper patient care. As such, I have been recruited to be a consultant on a committee that looks at diabetes care in our hospital. I have pointed out many errors and, admittedly, I have not always been diplomatic.

Recently, I came upon a case where I felt there was a huge error made, one which resulted in a trip to the ICU. I reported the case. It just so happened that there was a department meeting that evening during which the case was brought up. No, I didn't bring it up, though I was part of the discussion. No names were mentioned; just the circumstances of the case. Later, my associate received a message from the doctor involved. She will no longer be referring patients to us because she doesn't like my attitude.

Here's how I feel about that: Our job is patient care. That has to come first. If a doctor feels that a patient will get better care elsewhere, then it is her obligation to send the patient there. She should not, however, send a patient to a specialist just because that person is her buddy. On our side, again, patient care and patient safety has to come first. Would I like to be friendly with all the referring docs? Sure. But I won't compromise patient care for the sake of camaraderie. There are physicians I would send my patients to that I wouldn't want over for dinner, and there are physicians I love to chat with that I wouldn't want touching my patients.

Our primary role as physicians is to provide the best possible care for our patients. Unfortunately, sometimes egos need to get bruised and toes need to be stepped on to achieve this.