Avoiding Jousting in Podiatry

Marcy A. Metzgar

What Is Jousting?

In podiatry, “jousting” refers to a podiatrist criticizing another podiatrist’s treatment and assuming a patient received inadequate care. In turn, this perspective may motivate the patient to allege malpractice against the podiatrist that provided the initial care.

According to MedPro Group Chief Medical Officer Graham Billingham, “The risk of jousting can be greatly reduced by avoiding criticism of other providers, focusing on the present treatment plan, avoiding speculation, and keeping documentation objective.”

What Are the Outcomes and Liability Implications of Jousting?

Engaging in jousting can produce many negative outcomes for podiatrists. New patients may recall their previous experience with a podiatrist in a subjective — not objective — manner, so the subsequent podiatrist may not hear all the facts. The subsequent podiatrist may only hear part of the story as well, so they should consider communicating with the previous podiatrist to get more facts and read previous podiatric health records. Notations in the previous podiatrist’s records regarding the patient’s cooperation and compliance may be enlightening and prove useful in terms of treatment planning, patient education, and informed consent.

If a subsequent podiatrist makes assumptions and asserts to a patient that a previous podiatrist provided subpar care, the patient may seek retribution by filing a malpractice lawsuit. If the patient asserts a claim against the previous podiatrist, then the health records from both podiatrists will be examined during the litigation process. The subsequent podiatrist may also be identified as a material witness in a court trial, or a plaintiff’s attorney may try to use the subsequent podiatrist’s criticism as expert testimony.

Not only can a subsequent podiatrist become part of a lawsuit, but the jousting behavior can strain the professional relationship between the podiatrists and may have a negative effect on both podiatrists’ professional reputations. Further, the previous podiatrist may not have the opportunity to explain the care rendered, which can lead to loss of practice and finances.

Jousting also may change the way patients perceive podiatry and pursue podiatric care. Patients may lose faith and trust in podiatry and discontinue treatment, which in turn may affect their health and well-being.

Is Jousting Unethical?

According to the American Podiatric Medical Association Inc.’s Code of Ethics, “Knowingly or recklessly making false allegations, statements, or charges about a podiatric physician or any other medical professional [is] . . . a violation of this Code of Ethics and may be subject to disciplinary action.”¹ Therefore, jousting is considered unethical in podiatry.

It is incumbent upon every podiatrist to conduct themselves in an ethical and professional manner and to always do and say what is in the best interest of the patient’s health. However, treating new patients with previous negative experiences can present challenges, so it is best not to speculate or guess when discussing previous treatment. Although a podiatrist’s clinical skills and decisions are essential to patient safety and satisfaction, other unknown variables may have played an important role in the patient’s care and outcomes.

What Strategies Can Help Podiatrists?

To avoid any liability implications associated with jousting, following are some strategies podiatrists can use:

• Be wary of multiple opinions and patients who have a long history of previous podiatrists.
• Ask the patient to describe the previous treatment and recommendations received, including any prescribed medications and how they were taken. Be cautious of patients who will not reveal the previous podiatrist’s name nor give permission to contact them.
• If a patient asks whether a previous podiatrist provided inadequate care, do not comment on that treatment and instead specify what you found upon examination and your recommendations.
• Do not document anything in the patient’s record that reflects criticism of the previous podiatrist’s treatment. Simply state what can be substantiated.
• Follow ethical guidelines set forth by the American Podiatric Medical Association.
• Be thoughtful toward your fellow podiatrists/colleagues, and don’t perceive any encounter with another podiatrist as a competitive one.
• Be sure to practice thinking rationally and morally. Be more diligent and practice optimum restraint in selecting your words, especially about fellow podiatrists.
• Maintain the best interest of the patient as the top priority, but not at the expense of the podiatry profession and professional ethics.

In Summary

Many podiatrists have seen situations of past care that seemed inappropriate and ineffective. They also have listened to patients relaying critical comments about another podiatrist’s care. Yet, these situations might not reveal all the facts or details about the patient’s previous treatment. Thus, podiatrists must exercise caution in what they say to patients and what they document to avoid criticism that could potentially lead to malpractice allegations, loss of patient confidence, professional strain, and unethical behavior.

Endnotes

¹ American Podiatric Medical Association. (n.d.). American Podiatric Medical Association, Inc. Code of Ethics. Retrieved from www.apma.org/apmamain/document-server/?cfp=/apmamain/assets/file/public/about/code-of-ethics.pdf

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