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Medical Jousting: Think Well Before Speaking
what Is MedIcal JoustIng?
The historical meaning of jousting is to be engaged in a sporting contest in which two opponents on horseback fight with lances.[1]
In modern times, making derogatory remarks on a coworker/ colleague is called jousting. When such comment/criticism is made by a medical professional on the work/treatment of another doctor, it is termed as medical jousting.
why and By whoM Is It PRactIced?
In a common scenario, it is practiced by some doctors out of jealously against fellow colleagues in profession. It is usually done when the other doctor has more patients or the doctor who is making such comments has feeble knowledge about the field of other doctor. It is often seen that the practitioners of different streams/fields criticize the work of others because their intervention/modality of treatment is different.
how Is It PRactIced?
Medical jousting can be done by just making a statement which raises any type of question on the skill, efficiency, or efficacy of another practitioner. Comments like:
• Why the X‐rays were not taken?
• Why the blood work and other investigations were not done?
• Did the doctor examine the patient thoroughly?
• Did the surgery go well?
• Why the particular type of anesthesia/procedure was done
and not the alternative?
• Did the attending doctor take a second opinion before
initiating the treatment?
• Was the doctor sure of his diagnosis and treatment?[2]
• If you had come to me first, I would not have treated like
this.
• Your case has been spoilt; nothing can be done now.
• Who gave you this scar? This could’ve been avoided![3]
Such expressions constitute medical jousting.
when and wheRe Is It PRactIced?
Jousting is done by any doctor at his own clinic or hospital in front of patients or attenders or other colleagues.
Making a journal review, reference, or comparison from the work of another practitioner is allowed, but sheer criticism with intention of showing the other person down, using derogatory/filthy language, is not acceptable. Similarly, the “yellow journalism” is not welcome. When criticizing or noting down a fault in other person’s work, the critic should be
doubly sure and should check the background limitations and all other aspects of the study very carefully before indulging in criticism. The criticism should be healthy and the tone and tenor of language should be respectable.
RePeRcussIons of MedIcal JoustIng
If a case of jousting is noticed, it can be brought into the notice of the head of department/institution. The person if found guilty could be reprimanded and left with warning or may be restricted from department/institution for a considerable amount of time. The Medical Council of India states that what amounts to jousting is not allowed in the Medical Code of Ethics Regulations. Section 4.2 relates to conduct in consultation which states that in consultations, no insincerity, rivalry, or envy should be indulged. All due respect should be observed toward the physician in‐charge of the patient and no statement or remark be made, which would impair the confidence reposed in him. For this purpose, no discussion should be carried in the presence of the patient or his representative.[4]
By passing any such comments, the one who is criticizing may land up in legal hassles if such comments are recorded and made viral or used in the court as evidence.
PReventIon
Taking in consideration the Declaration of Geneva, every colleague should be considered as brother or sister and no enmity or jealousy should be kept for any fellow colleague.[5] If a reference is made for a patient who received primary treatment from another physician and if at all any incompetency is found, it should better not be mentioned to the patient or attender and if very important, it can be discussed by the physician in‐charge personally. Discuss the problem/complication with the patient in a way that it should not be offending for another physician. Avoid making any personal or professional comment for any fellow colleague regarding any case in front of any outsider/ nonmedico population.
Medical jousting may add onto the incidents of violence against the doctors and may worsen the situation for the medical practitioners all over the country. Medical jousting wittingly or unwittingly exists. It appears to be on increase. This is an avoidable and unnecessary evil encompassing clinical practice. Medical doctors should refrain from criticizing their colleagues in front of patients and their attendants in the interest of the medical profession. They should be united and support each other.[6] Better that the medical professionals desist from medical jousting.
Financial support and sponsorship
Nil.
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Conflicts of interest
There are no conflicts of interest.

6. Subrahmanyam BV, Veera Nagi Reddy G, Phanindra SV, Subba Rao KS. Medical jousting: Ethical and legal implications. Narayana Med J 2017;6:68‐70. Available from: https://www.ejmanager.com/ mnstemps/69/69‐1497600639.pdf?t=1569383487. [Last accessed on 2019 Sep 25].
   This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‐NonCommercial‐ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non‐commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
   Departments of Forensic Medicine and Toxicology and 1Pharmacology, People’s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
   Address for correspondence: Dr. Vijay Thawani, Department of Pharmacology, People’s College of Medical Sciences and Research Centre, Bhopal ‐ 462 037, Madhya Pradesh, India. E‐mail: vijaythawani@rediffmail.com
   RefeRences
7. Cambridge Dictionary. Available from: https://dictionary.cambridge. org/dictionary/english/joust. [Last accessed on 2019 Sep 24].
8. Ashok DS. Medical Jousting: The no win conundrum for everyone. J Edu Res Med Teach 2017;5:30‐2.
9. Rawat S. Avoid Medical Jousting Please. DHRC e‐Connect. Dharamshila Hospital; February, 2017. Available from: http://www. dhrc.in/downloads/DHRC‐Newsletter‐Feb‐2017.pdf. [Last accessed on 2019 Sept 25].
10. Medical Council of India. Code of Medical Ethics. https://www.mciindia. org/documents/rulesAndRegulations/Ethics%20Regulations‐2002.pdf Page 6. 19. [Last accessed on 2019 Sep 24].
11. Praveen G, Akkaloori A. The revised Declaration of Geneva, 2017, and India’s contradictory legal provisions. Indian J Med Ethics 2018;3:254.
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    DOI:
    10.4103/jmgims.jmgims_63_19
    Anjali Agrawal, Vijay Thawani1
    Letter to the Editor
    Journal of Mahatma Gandhi Institute of Medical Sciences ¦ Volume 25 ¦ Issue 1 ¦ January‐June 2020 51
    How to cite this article: Agrawal A, Thawani V. Medical jousting: Think well before speaking. J Mahatma Gandhi Inst Med Sci 2020;25:50‐1.
    Received: 26 September 2019 Revised: 16 January 2020
    Accepted: 09 January 2020 Published: 14 April 2020
    © 2020 Journal of Mahatma Gandhi Institute of Medical Sciences | Published by Wolters Kluwer ‐ Medknow