Study: Most doctors have been untruthful
Study: Most doctors have been untruthful
Lying was "routine for years"
One out of 10 physicians said they had told a patient something untrue in the previous year, according to a 2009 survey of 1,891 practicing physicians nationwide.1
Barron H. Lerner, MD, professor of medicine and public health at the Columbia University's Mailman School of Public Health in New York City, says the fact that a fair percentage of physicians admit to lying to patients isn't too surprising. "This was routine for years. In the 1950s and 1960s, lying was rampant in medicine," he says. "You wouldn't expect a 180 degree turn from the past."
It was once commonplace for physicians to "protect" patients by concealing a diagnosis of cancer, adds Lerner. "With the rise of informed consent and autonomy, the pendulum swung away from the paternalistic mindset of protecting people from bad news," he says.
Today's medical students are taught never to lie to patients as an ethical standard, "but I think that is unrealistic," says Lerner. "It's easy to say if you are sitting around a conference table, but with a real patient in front of you, things are more complicated."
Craig Bates, MD, MS, FACEP, clinical assistant professor of emergency medicine at Case School of Medicine and an attending emergency medicine physician at MetroHealth Medical Center, both in Cleveland, OH, says the study "definitely has worrisome results. We all like to believe that physicians are truthful most of the time."
However, Bates notes that interactions with patients are more complicated than single encounters with direct questions and answers would suggest. "There is a lot of information involved in modern health care. Physicians often have to heavily filter this information for patients," he explains.
This can result in information not being passed along to patients, either unintentionally or because it doesn't seem relevant. "If a physician's judgment is off when making those determinations, the result can be major information that is not shared with patients," Bates says.
Here are other key findings from the survey:
More than a third of surveyed physicians said it is sometimes OK not to disclose significant medical errors to affected patients.
"Fifty years ago, doctors almost never told patients about errors," says Lerner. "I'll admit that in practice there are often mitigating circumstances. You can't just go marching around the hospital announcing to patients every single time there is an error."
Physicians may need to get comfortable with error disclosure by asking others with expertise for help, such as hospital risk managers. "When I was in medical school, nobody told us how to break bad news," says Lerner. "People did it all the time, but nobody talked about it."
There are now dozens of articles on the Internet on the topic, he notes, with protocols including turning off beepers and giving the patient a hug. "People have been educated on how to do an uncomfortable thing better," he says, adding that the same can happen for error disclosure.
A physician's first inclination may be to hide the error, adds Lerner, "but you have to catch yourself and say, 'wait a minute, times have changed,'" he says. "I'm a strong advocate of disclosing errors. I feel patients deserve to know, and I disclose errors as best I can."
More than a third of surveyed physicians said it is sometimes OK to hide financial relationships with pharmaceutical companies and device makers from patients.
"To me, that is black and white, and I don't see any wiggle room. I think every single patient deserves to know every single potential conflict of interest," says Lerner. "Study after study has shown that doctors are influenced by money."
Lerner suggests that a physician might say to a patient, "I feel obligated to tell you something. This might surprise you, but if this bothers you in any way, here is my phone number and I'm happy to talk to you."
Reference
- Iezzoni LI, Rao SR, DesRoches CM, et al. Survey shows that at least some physicians are not always open or honest with patients. Health Affairs 2012;31(2):383-391.
Sources
Craig Bates, MD, MS, FACEP, Clinical Assistant Professor of Emergency Medicine, Case School of Medicine, Cleveland, OH. Phone: (216) 778-2100. Fax: (216) 778-2400. Email: [email protected].
Barron H. Lerner, MD, Professor of Medicine and Public Health, Mailman School of Public Health, Columbia University, New York City. Phone: (212) 305-5154. Fax: (212) 342-1986. Email: [email protected].
One out of 10 physicians said they had told a patient something untrue in the previous year, according to a 2009 survey of 1,891 practicing physicians nationwide.1Subscribe Now for Access
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