Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

We Just Disagree


When colleagues offer a conflicting opinion, remember to always put the patient first, check your facts, and be open to learning.  

I was recently confronted by an infectious disease specialist who, while caring for a loved one, espoused to me his belief that COVID was a “political, not a real disease.” His diatribe was based not on science, but on a political agenda that clearly distorted his medical judgment. It had no place in a discussion of patient care.  


The interaction was made worse because not only was the patient my mother, but it was a discussion between medical colleagues and there should have been mutual respect. The hurt inflicted on me was magnified further when he had the same discussion with my father, sitting at my critically ill mother’s bedside. Let’s call that an unprofessional disagreement. I detailed this awful experience in an essay titled “Betrayal” in “The American Journal of Medicine.” 


The incident made me think about professional disagreements . . . situations where our opinion differs from that of a colleague about the interpretation of a diagnostic test, a procedure to be ordered, or a treatment to be rendered. Such situations come about regularly, and raise the question: how best to handle them? Here are some things to consider: 


1. Check your ego at the door.

Medical hubris has no place in these discussions. It can deafen you to things you need to hear. 


2. Check your facts.

I’ve never met anyone, including the internist who looks back at me in the mirror, who’s never made a mistake. Be sure your facts are correct. Was the test result as you recalled? Were the previous treatments you thought you’d rendered actually administered? Factual errors can easily lead to errors in conclusion.  


3. Put your patient first.

These discussions should be all about patient care. And as a corollary, never put the patient in the middle of a disagreement between colleagues. It’s not about us, it’s about them and their care.  


4. Learn.

Perhaps this is a situation where your colleague knows something you don’t or has a perspective you’ve never considered. Welcome and embrace the opportunity to learn. 


5. Teach. Perhaps this is a situation where you’ve read a study or tried a treatment that your colleague hasn’t. Offer your knowledge graciously, openly, and with the intent of teaching, not of “showing up” anyone. 


6. Maybe we’re both right?

Medicine is both beautiful and frustrating at times because of the nuances that abound. Often, there’s no one right answer. One may prefer penicillin VK for strep pharyngitis, while another prefers amoxicillin. I may have read a wonderful study of olmesartan, while my colleague regularly prescribes losartan. Is one right while the other wrong? Or are these just subtle differences in direction that ultimately get us to where we want to go? 


7. Communicate.

Nothing good will come from a professional disagreement if it’s not discussed by those involved. Communicate with your colleague(s) with respect and an open mind. 


Professional disagreements will happen. But we should approach them with the lyrics of the Dave Mason song (written by Marko Perko and Jim Krueger) in our minds: 


There ain’t no good guy
There ain’t no bad guy
There’s only you and me
And we just disagree. 










This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.