According to Dr. Tobias,MD, JD, who is a  California consultant with a law degree and advises physicians who are in trouble with hospitals, the following tips provide a plan on speaking out. He provides this strategy in an interview with Medscape.

“Because making critical statements can have serious consequences, it’s important for doctors to move forward cautiously. “Don’t go off half-cocked.  “Your whole career could be at stake here.”

Ask yourself whether it’s worth it. When you are tempted to speak out, start by having a conversation with yourself. Is making an issue here worth the possible negative consequences to your career? “You should ask yourself, ‘Am I overreacting here?'” Dr. Tobias said. He conceded that it’s hard to answer that question. “What’s worth bringing up is in the mind of the beholder. A major issue for you may be a minor one to me.”

Understand your motives. When you want to turn someone in, are you reacting to a personality conflict rather than a major problem? “In a personality conflict, you’re looking for something negative about the other person,” Dr. Tobias said. “You can pick away at it and blow it out of all proportion.”

Consult a trusted colleague. To truly understand whether you have a real point and don’t have an axe to grind, bounce your concerns off a trusted colleague. You might also consult with a widely trusted older physician on staff who is not part of the hospital hierarchy, Dr. Tobias added. But don’t ask competing physicians who aren’t close friends, because they might not keep it to themselves, he advised.

Check your facts. Before you make an accusation, “you’d better have the facts down,” Dr. Tobias said. “If you’re wrong, you’ll be having to extract your foot from your mouth, and you might even be sued for libel.”

Be discreet. “Be tactful,” Dr. Tobias advised. “There’s a right way to complain.” This involves being polite and using the proper channels, starting by talking to your department head. And in any case, don’t take your case to the media. “If you go to your local newspaper, you’re going to be labeled a disruptive physician, and you’re going to be taken off the staff very quickly,” he said.

Try to settle the matter privately. Dr. Tobias said the physician who was criticizing colleagues in the chart could instead have discreetly contacted the people he was criticizing. The same applies to criticizing colleagues or staff in public places. “If you have a problem with a nurse, don’t correct her in front of patients,” he said. “Ask her to go with you into a separate room and say, ‘Let me show you how to do it.'” And don’t lose your temper, or else the hospital may label you a “disruptive physician.”

Don’t just be a critic. When you see a problem, rather than just criticizing, think about how it could be fixed, and be sure to address the administration’s concerns, such as added expenses. Dr. Tobias said he defended a doctor who complained that his hospital’s laboratory was not providing certain test results fast enough. The doctor suggested another process that was much more expensive, but he insisted money should be no object. “He would not let up, and they were going to take him off the staff,” Dr. Tobias recalled. Dr. Tobias was asked to intercede, and he and the head of pathology came up with a better testing process that did not cost a lot more money.

Speaking up against powerful people often comes at a price. “When you have to protect patient care, it usually means going against some rule of the administration,” Dr. Tobias said. But be aware that there are good ways and bad ways to speak out. “Be careful what you say, and don’t go flying off the handle,” he said.


This is sage advice for those who need associations with hospitals.  Regardless of whether the hospitals are employers for the doctors or affiliations for which patients will be referred and cared for, the link to the hospitals are key.  Jeopardizing the relationship can be  professional suicide.

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