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Patient-Physician Relationships

Written by Matthew L. Fink, Esquire* & Harry M. Roth, Esquire

A recently published survey in the journal Health Affairs, revealed that one in ten doctors has lied to at least one patient in the past year. Nearly twenty percent of the doctors surveyed admitted to not telling a patient about an error. Ten percent said they did not disclose a financial conflict of interest and 15 percent said they painted a rosier picture than they knew to be true. While most doctors agree that they should not lie to patients, the survey responses raise many questions about whether and how that belief is put into practice.

An expert in medical ethics, Arthur Caplan, Ph.D. thinks that truth-telling should not be absolute in doctor-patient communications. Dr. Caplan endorses some “fibs” and some omissions, specifically those “fibs” where the goal is to improve the overall health of the patient. For instance it Dr. Caplan questions “bending the truth is not all that bad” if doing so may scare the patient into losing weight, reduce alcohol consumption or wear a bicycle helmet. Similarly, Dr. Caplan suggests that while it’s not right to be overly optimistic about a poor prognosis, telling the patient the entirety of a bad prognosis in stages may be acceptable out or respect for a patient’s emotions. Without disregarding the communications challenges doctors face several times each and every day, this feels like the proverbial slippery slope where ends, subjectively evaluated by the physician, may be deemed to justify means that under other circumstances and in other professions are not tolerated. It is fair to question whether accepting even fibs and omissions – even if we could agree were for the right reasons – doesn’t send the message to doctors that it is ok to lie and omit more serious facts from the patient.

Consider the statistics from the survey referred to above: fifteen percent of doctors said they painted a rosier picture, yet there were 20 percent of doctors that admitted to concealing errors in medical treatment from patients. Dr. Caplan rightly condemns doctors who conceal errors from their patients but the fact is fewer doctors engage in the types of “fibs” and exaggerations that Mr. Caplan deems acceptable than engage in the type of lies that Mr. Caplan deems unacceptable. Tolerating untruths in some circumstances places a burden of judgment onto the doctors of deciding what lies are acceptable and what lies are not acceptable. Worse, the unfortunate truth is that “patient well being” could serve as a rationale for even those lies that all could agree are improper.

In February of 2002, the American Board of Internal Medicine, in conjunction with several other medical boards and professional groups published the Charter on Medical Professionalism. One of the professional responsibilities outlined in the Charter is the Commitment to Honesty with Patients. Here, the importance of complete and full honesty with a patient both before and after treatment is outlined. Even where mistakes occur, or a prognosis is grim, the Charter recognizes the obligation of candor in order to assure that patient and societal trust is never compromised.

These statistics clearly show that different doctors nevertheless believe that degrees of candor are allowable. When doctors receive mixed messages about lying to patients, some doctors will default to lies that are convenient or make life easier or are self-interested.

Lying is easy, but the choices that face doctors and patients are far from easy. They are complicated, uncertain and impact lives. In order to deal with these complicated decisions, a patient should have full knowledge of their situation so that they are better able to assess their options. Physicians should have confidence in the durability of their patients and attend to building the type of relationship such that even in delivering the worst of news, they are trusted and counted on as a partner in seeking treatment or comfort. At the end of the day, honesty, no matter how painful it is, is the best policy.

References:
Medical Professionalism in the New Millennium: A Physician Charter, February 2002, (https://www.annals.org/content/136/3/243.full)

* Matthew L. Fink, Esquire is a Pennsylvania lawyer who works with Cohen Placitella & Roth on pharmaceutical and securities matters.

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