What to do when covering for another healthcare provider and disagreeing with their treatment plan or prescribing practice?

Managing Disagreement with Another Provider's Treatment Plan While Covering

When covering for another provider and you identify a treatment plan that poses immediate patient safety concerns or falls outside accepted medical practice, you should intervene to protect the patient while simultaneously initiating a systematic conflict resolution process that respects professional relationships and procedural fairness. 1

Immediate Assessment Framework

Before taking action, pause to verify your concerns are justified by asking yourself: 1

• Are the facts clear? Confirm you have complete information about the patient's condition, prior discussions, and rationale for the current plan 1
• Are your assumptions verified? Ensure you're not missing context about patient preferences, prior failed treatments, or specialty-specific considerations 1
• Have you checked for moral blind spots? Consider whether your disagreement stems from different but equally valid clinical approaches versus actual inappropriate care 1

Categorizing the Disagreement

Your response depends on the nature of the disagreement: 1

Strictly Futile Interventions

• If the treatment literally cannot accomplish its intended physiologic goal, you should not provide it 1
• Clearly explain the rationale to the patient/family and obtain expert consultation if disagreement persists 1

Potentially Inappropriate but Not Futile

• If the treatment has some chance of working but competing ethical considerations suggest it shouldn't be provided, this requires the full conflict resolution process 1
• You should communicate and advocate for what you believe is appropriate while working toward negotiated agreement 1

Preference-Sensitive Decisions

• If this is a matter of clinical judgment where multiple approaches are acceptable, defer to the primary provider's plan unless patient safety is compromised 1
• Document your assessment and communicate directly with the primary provider 1

Systematic Conflict Resolution Process

When disagreement persists, follow this structured approach: 1, 2

Step 1: Redouble Communication Efforts

• Engage in intensive communication with the patient/family to understand their values, goals, and the rationale behind current decisions 1
• Contact the primary provider directly to understand their clinical reasoning and discuss your concerns 2
• Seek assistance from consultants skilled in mediation and conflict resolution who are separate from any formal review process 1

Step 2: Obtain Second Opinion

• Get an independent second opinion from another clinician with expertise in the patient's condition 1
• This should address both prognosis and whether the treatment is inappropriate 1

Step 3: Engage Ethics Consultation

• If disagreement remains intractable, involve your institution's clinical ethics committee 1, 2
• The committee should be interdisciplinary with members not directly involved in the patient's care 1
• Provide written notification to all parties about the formal conflict resolution process 1

Step 4: Document Thoroughly

• Record your clinical reasoning for considering the plan inappropriate 3
• Document all discussions with patients, families, and the primary provider 1
• Ensure your documentation is dated and includes the conflict resolution steps taken 1

Time-Pressured Situations

When clinical urgency prevents completing the full process: 1

• Initiate a temporizing treatment plan that doesn't include the contested intervention if you have high certainty it's outside accepted practice 1
• Engage other clinicians immediately to ensure consensus regarding your decision 1
• Complete as much of the conflict resolution process as possible given the time constraints 1
• Explain your reasoning to the patient/family with the goal of reaching mutual agreement 1

Critical Pitfalls to Avoid

Do not unilaterally discontinue treatments without following due process unless they are strictly futile or the situation is immediately life-threatening 1. Approximately 48% of patients will follow physician recommendations even when it contradicts their initial preferences, and this can lead to decreased satisfaction 4. This underscores why procedural fairness matters—your authority as the covering provider can inappropriately override patient autonomy if not handled carefully.

Do not assume you have complete information about the patient's values, prior discussions, or failed treatment attempts 1. Studies show that comprehensive medication reviews and treatment discussions are uncommon in routine practice, meaning important context may not be documented 5.

Do not let professional courtesy prevent you from acting when patient safety is genuinely at risk 2. The American College of Nursing emphasizes that nurses and physicians must advocate for patients when organizational or resource constraints threaten dignified care—this applies equally to covering providers 2.

Shared Decision-Making Principles

Throughout this process, maintain the three-element shared decision-making model: 2

• Information exchange: Ensure the patient/surrogate shares their values, goals, and preferences while you provide clear medical information 2
• Deliberation: Discuss together which option aligns best with the patient's values 2
• Making a treatment decision: Work toward a mutually agreed-upon care plan 2

When to Proceed Despite Disagreement

If the ethics committee agrees with your assessment, no willing alternative provider can be found, and appeals processes are exhausted, you may withhold or withdraw the contested treatment while providing high-quality palliative care 1. However, this represents the endpoint of a thorough procedural process, not an initial response.