If one of your patients asked your opinion of another doctor whom you know to be incompetent what would you tell your patient?

Incompetence in a physician is a scary thing! Doctors deal with problems of life and death and try to heal you with dangerous tools. A doc that isn’t competent can be seriously dangerous.

But how do you know who’s on their game and who’s falling down on the job? It’s tricky for patients because they often don’t know enough about medicine practice to judge competency. This makes putting your body under the care of any doctor scary.

So scary, in fact, that an entire malpractice industry has sprung up to reassure patients that incompetent doctors will be severely punished. Unfortunately malpractice usually ends up a witch hunt that can burn good doctors at the stake and let bad ones go

Wouldn’t it be nice if you had someone who understands medicine who could tip you off on the bad ones? Yes, but it’s a complicated thing to ask your doc if another doc is incompetent or not.

Judge not, lest you be judged

Competence is not always as black and white as you might think. There is a good bit of gray and ambiguity involved. The real world practice of medicine involves a lot of educated guessing and trial and error. Even the best doctors occasionally make mistakes or use unorthodox treatments.

The real dangerous doctors are the ones that recklessly disregard patient safety and don’t even care about doing things right. And yes, unfortunately there are lots of doctors like this.

Incompetence may be common, but it is hard to prove. Doctor D occasionally sees signs of suspected incompetence in patients that have been treated by other docs. An incorrect diagnosis or an unorthodox treatment that seems way out of the expected margin of error and puts a patient at risk.

But these clues in the crime can be misleading. Sometimes Doctor D will see something and say to himself, “Self, what this doctor is doing makes no sense. I wonder if he is incompetent?” Later I met the doc only to find that he had an excellent reasoning for what he did, and was obviously acting in his patient’s best interest.

The medical gestapo

But there are some doctors that are all too happy to accuse their colleagues of incompetence. These docs believe there is only ONE competent way to practice medicine, and it is the way THEY practice.

These doctors want to be the to secret police who keep medicine in line. They are typically jerks with a massive god-complex. They gleefully tell every patient who will listen which doctors they think suck.

Doctor D has had encounters with the medical gestapo. They shoot first and ask questions later. They see the world in black and white. There is no gray area for them.

“Doctor D you didn’t follow the protocol! Are you thinking for yourself? Are you adjusting the protocol for individual patient’s situations? Off to the firing squad!”

Dealing with Dr. Danger

Witch hunts both from within and without medicine have soiled the names of a lot of good doctors. So Doctor D is always careful about fingering another doctor as a dangerous doc, even when he has his suspicions.

I currently know a doc who I am about 70% certain is a walking public health threat. I’ve seen a pattern of “WTF?!” medical decisions that make me highly suspicious that this dude either doesn’t know what he’s doing or doesn’t care.

How certain do I need to before turn Dr. Danger over to be burned at the stake? Well 100% actually.

I’ve been a target of the Medical Gestapo myself, and I know how damaging misguided doctor purges can be. I’m not blowing the whistle on Dr. Danger unless I know beyond a shadow of a doubt that he’s really what I think he is.

I’ve only been 100% certain one time before and that time I blew the whistle as loud as I could.

Subtle warnings

Although I’m not absolutely certain he’s incompetent, I wouldn’t want any of my family seeing Dr. Danger. It would be too much of a risk!

I can’t flat-out denounce him publicly, but I do want to steer patients away from the danger I suspect.

This is where subtlety comes in handy:

I might say “Dr. Danger does some really unorthodox things.” Or I might just fail to praise him, while my facial frown indicates I might not be totally cool with Dr. Danger. Or I could just change the subject and suggest you see Dr. Awesome instead.

This is how we doctors subtly steer you away from potential danger.

But you have to read between the lines, because if you flat out ask, “So Doctor D are implying you think Dr. Danger is totally incompetent and has no business practicing medicine?” Doctor D will smile and say, “Oh no, Dr. Danger is a delightful person! You have totally misunderstood me!” Then D will give you a wink.

Doctor D puts the B in subtle!

“Doctor D” is a physician who blogs at Ask An MD.

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