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.