Do doctors have to be honest?

Posted: February 28, 2012

By Arthur Caplan

Think your doctor is telling you the truth? According to a survey recently published in the journal Health Affairs, he may well not be.

The study found that one in 10 doctors has lied to at least one patient in the past year. Twenty percent of the 2,000 doctors surveyed admitted they had not told patients the truth about an error. Ten percent said they had failed to disclose financial conflicts of interest. And 15 percent said they had painted a rosier picture of a patient's prognosis than they knew to be true.

So why is there so much dissembling by doctors, whose codes of ethics obligate them to be truthful? Shouldn't we expect our physicians to be honest when it comes to our health? Should medical schools spend more time reminding doctors that they shouldn't fib?

My answer as an expert in medical ethics is - believe it or not - no.

True, some lies are inexcusable. If there is a mistake that affects patient care or costs, it has to be disclosed. A doctor may dodge a malpractice bullet by hiding an error from a patient or the patient's family, but if the error is eventually discovered, the doctor can expect to be clobbered in court, and rightly so.

With respect to financial conflicts of interest, patients have a right to know about them when they are significant. Yes, some patients don't care, but the truth should at least be disclosed to them, whether they choose to pay attention or not.

Delivering very bad news to patients, however, is a thornier subject. Patients need to know the truth, but they almost always want hope, too. Often, bad news should be delivered over time, not all at once. In medicine, truth is sometimes best seen as a process, not an event.

It is not right for doctors to pretend to be optimistic about facts that they know to be grim. But out of respect for a patient's emotions, letting the truth out in drips rather than a flood may be the best route to follow.

Putting aside the difficult task of softening a bad prognosis, what about the practice of exaggerating risks? Is it wrong to "up the ante" a bit to try to scare a patient into losing weight, giving up drinking, wearing a bicycle helmet, monitoring his blood sugar, or taking his medicine the way it was prescribed?

If the goal is to improve the health of the patient, and fudging the risk a tiny bit toward the nastier side results in lower blood pressure or prevents a skull from being cracked, then bending the truth is not all that bad.

Telling the truth is essential to maintaining trust between doctors and patients. But presenting the truth in a humane way - or fibbing to help ensure that a patient will still be around to trust the doctor in the future - may be just as important to good doctor-patient relations.


Arthur Caplan is a professor of medical ethics and health policy and the director of the Center for Bioethics at the University of Pennsylvania. He can be reached at caplan@mail.med.upenn.edu.

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