If I had cancer, would you tell me straight up? Even if you knew that I only had a few months to live? What if you knew that I had only a 5% chance of surviving for five years? What exactly would you share with me? Or my wife or children? What if you were my doctor?
A recent article in Health Affairs concludes that recent survey results demonstrate that doctors do not always tell patients the whole truth. As the Washington Post “Wonkblog” notes, eleven percent of physicians admitted to telling less than the truth. Indeed, fifty five percent of the doctors confessed to painting “a more positive prognosis than warranted.” Perhaps more troubling, nearly 20% of respondents said that they did not fess up to a medical mistake and that 28% revealed “protected” confidential information about patients. What does all of this say about our doctors and our doctor/patient relationships?
The Massachusetts Survey done in 2009 does not address why doctors fib, so we are left to speculate. The most common lie would seem to be an effort by caring physicians to give patients hope for better health, even though a cure or survival or improvement is not likely. Knowing that hope is a powerful contributor to well being, doctors, who all have seen “miraculous” and inexplicable cures and recovery, want patients to have a chance. But is it a disservice to the dying who would be better served getting their affairs in order?
And not opening up about a mistake made in a patient’s care? Of course, the fear of a lawsuit is a powerful motivator of physician behavior. Despite recent research that has shown that admitting error may protect caregivers from malpractice suits, one out of five practitioners choose to mislead. Without a deep and trusting relationship with the patient, doctors are reluctant to admit a mistake that could come back to haunt them in a court of law.
And what about revealing confidential information to an “unauthorized” person? Of course, the cumbersome HIPAA regulation can make the wife or child “unauthorized,” but the fact is that a trusting relationship will overcome these hurdles of revelation.
So doctors do not always tell the truth. In fact, that is nothing new. Hippocrates’s admonition, “Above all, do no harm” can be interpreted in several ways. But what is clear in all of this discussion is that the doctor/patient relationship has suffered from hurried office visits in a social networking world. To be completely honest, the doctor must know the patient intimately. He must know the patient’s hopes and dreams and fears. And he must know the very world that the patient inhabits. When even a prescription refill is sent electronically, “drive by” office encounters that allow little face time with the physician only breed distrust and questions about value.
The truth is that doctors today are too hurried to learn who we are and what we truly care about in our lives. Caring about my disease is not enough. If you do not know me, honesty is not so compelling.
Sometimes the truth hurts.