Some doctors shield whole truth from patients, survey shows
■ Though most physicians are committed to honest communication, a few admit to dissembling about medical errors, industry relationships and other matters.
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A majority of physicians told a patient that his or her prognosis was more positive than the medical facts warranted within the previous year. More than a third say it is sometimes OK to shield significant medical errors from affected patients or hide financial relationships with pharmaceutical companies and device makers from patients.
These are just a few of the areas in which at least some physicians say that always telling patients the whole story is not the right way to go, according to a nationwide survey of nearly 2,000 doctors across seven specialties in the February issue of Health Affairs.
"Despite widespread acceptance of communication principles and commitments by professional organizations, substantial percentages of U.S. physicians did not completely endorse these precepts, and many reported behaving in ways that deviated from these norms," said the study (link).
For example, 11% of physicians said they might sometimes tell a patient something untrue, and about the same number said they had lied to a patient in the prior year. About 20% of doctors said they failed to disclose a mistake to a patient within the previous year because they feared a lawsuit. Many of the items on the survey, conducted in 2009, are based on ethical standards in Medical Professionalism in the New Millennium: A Physician Charter. That 2002 document has been endorsed by more than 100 organizations, including the American Medical Association.
"What we're talking about in this paper -- honesty with patients -- really affects everything," said Lisa I. Iezzoni, MD, lead author of the study. "This doesn't just affect people who have a certain type of disease or a certain ethnic, age or gender group. This really affects everybody."
The study found some differences in responses to various questions that were linked to physician specialty, gender and other characteristics. However, there was no overall pattern linking a doctor's background and his or her commitment to telling patients the truth.
Fifty-five percent of physicians were willing to paint a brighter picture of patient prognoses. That finding surprised Dr. Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. Many factors could be driving these doctors' actions, she said.
"They could be trying to be kind to patients, not worry them, not upset them," she said. "They could have very altruistic reasons for not telling the patients the devastating nature of the diagnosis the patients might be confronting. But at the end of the day ... for patients to be able to make good decisions about their health and their health care, they need to know what's going on."
In 2006, the AMA House of Delegates adopted ethics policy saying that physicians should not withhold medical information from patients, because doing so "creates a conflict between the physician's obligations to promote patients' welfare and respect for their autonomy by communicating truthfully."
Medical norms slow to change
What appear to be troubling findings about physician honesty with patients actually may represent progress in moving beyond medicine's long-engrained culture of paternalism, said Howard A. Brody, MD, PhD, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston.
"These ethical standards were promulgated in the face of a culture in medical practice that was the opposite, where for years and years the withholding of information and supposedly benign white lies to patients about their conditions and hiding information about legal trouble was the norm," Dr. Brody said. "It's discouraging that more physicians aren't totally on board, but how long do you expect it to take for the old culture to die out?"
If the same survey had been conducted a decade ago, the number of physicians willing to lie to patients in some cases probably would have been higher, Dr. Brody said.
"What we're seeing here might actually constitute an improvement from the way things were in the past," he said.