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The Truth About Lying to Patients

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Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 325,000 page views, and he has over 4100 followers on Twitter.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 325,000 page views, and he has over 4100 followers on Twitter.

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Many of the lies we tell patients are not intended to be malicious nor deliberately deceiving, but they are still lies in the strict sense of the word.
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A recent survey published in Health Affairs found that 20% of nearly 2,000 physician respondents said that “they had not fully disclosed mistakes to patients for fear of being sued” in the past year. When I first heard about this, I tweeted the following, “And 80% lied.”

Now that I’ve had a chance to think about it, I still feel that way. Is it possible that 80% of the surveyed doctors did not make a single mistake over the course of a year? I would guess that many doctors who practice full time would have been likely to have made more than one error that led to significant harm to a patient. Do you think 80% of them owned up to it to the patient or his family?

I don’t think so. As much as it would be nice to live in an ideal world, we don’t. Despite research and assurances to the contrary, most doctors I know are not ready to confess their sins to patients because they do fear lawsuits. And that fear is well-founded. But it is unfortunate because in my limited experience (hard as it is to believe, I’ve made my share of mistakes), patients and families generally do take it well when you admit that you made a mistake and more importantly, say you are sorry.

One bright spot. (I’m not surprised at this.) The paper said, “General surgeons and pediatricians were most likely to completely agree about needing to disclose all serious medical errors to patients, while cardiologists and psychiatrists were least likely to report this attitude (p < 0:001).”

Having read the entire Health Affairs paper, which is entitled “Survey Shows That at Least Some Physicians Are Not Always Open or Honest with Patients,” I can point out another finding that did not receive enough attention: 89% of physicians said that in the past year they never told a patient something that wasn’t true.

I am equally skeptical of that statement. Think about it. We have many opportunities to lie to patients. Many of them can at least be partially justified. In the so-called “informed consent” discussion, we don’t disclose every possible complication that has ever been associated with a procedure. If we did, no patient would ever consent to anything. What about injecting some local anesthesia and saying, “This won’t hurt. It’s just like a mosquito bite.” There are many more.

Many of the lies we tell patients are not intended to be malicious nor deliberately deceiving, but they are still lies in the strict sense of the word. The bigger problem of disclosing errors in an honest and forthright way will happen more often when the punitive culture of medicine changes.

I do not expect to see that happen soon.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last two years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 325,000 page views, and he has over 4100 followers on Twitter.

5 Comments

  1. Bob, I appreciate your comments. I wonder if you read past the second paragraph of the post.

    Take this sentence “I can point out another finding that did not receive enough attention: 89% of physicians said that in the past year they never told a patient something that wasn’t true.”

    I then go on cite examples of the white lies and well-intentioned omissions. 1 of every 8000 patients who have general anesthesia dies. Should we tell every hernia patient that?

    It’s interesting that you chose to mention an incident where a resident had trouble with an intubation. Did you tell the patient’s family before the procedure that a resident was going to do it and that she had not done many?

    Reply
  2. I find your perception that 100% of physician lie to their patients disgusting. I suggest that this perception is more reflective of you and your attitudes towards lying than an observation of physicians as a whole.

    People who lie and cheat are likely to perceive that everyone does so. I suspect that you are someone who lies and perceives that everyone else must as well.

    I am reminded of a time when I was in medical school and I discovered several students were cheating on the surgery clerkship exam. I confronted one of the students about this, and his response was that everybody cheats. Ultimately, I reported this to the administration, but not a single cheater came forward to admit their wrong-doing. The exam had to be re-written, at great nuisance to the surgeons.

    I am a practicing ICU physician at a teaching hospital. When errors are made, we disclose them to the patient. I recently had one patient where the resident was performing an endotracheal intubation, where she had some difficulty performing the procedure, which led to transient desaturation and mild laryngeal trauma.. I disclosed these facts to the patient and family immediately after the procedure. I have never been sued for disclosing the truth. Patients are appreciative of honesty.

    When I consent someone for a procedure, I review all worst-case outcomes, including death and irreversible brain damage.

    I have witnessed some physicians who deceive their patients, or omit full disclosure. I believe that the majority physicians do not.

    Reply
    • Have any of you interviewed a patient after 7 fail surgeries and 9 years of pending litigation? I’ll bet you he is probably one of the most paraniod people in the world.

      Reply
  3. Related (I wonder?)…not long ago I read a story recapping a study demonstrating that doctors do not out their own errors, they fail consistently report known errors by colleagues.

    Reply
    • Thank you for commenting. Most doctors do not report their errors or the errors of others. The culture of medicine is not like that of aviation, which does not punish pilots for speaking up. In medicine, the culture is punitive.

      Errors are discussed at conferences such as morbidity and mortality and at quality assurance committee meetings. Minutes of both of those meetings are allegedly confidential although some courts re beginning to rule otherwise.

      Reply

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