Blog | Monday, March 26, 2012

Honesty in medical practice: Do doctors always (sometimes) tell the truth?

"... resolve to be honest at all events; and if in your own judgment you cannot be an honest lawyer, resolve to be honest without being a lawyer."

Lincoln Memorial at night by rjv541 via Flickr and a Creative Commons licenseNo need to identify the authorship of the above quotation, which should be known by all discerning readers, such as those who feast on the weekly Whistleblower offering. For those who have suffered a cognitive lapse, I will provide four identity clues. Take a guess after each clue. If after the fourth clue, you are still clueless, then politely request a fifth and sixth clue in the comments section, and they will be provided to you.

1) He had a high pitched voice.
2) He was prone to depression and melancholy.
3) He was an ambitious and successful attorney.
4) He was known as "the rail-splitter."

Honesty in medicine is a fundamental pillar of our profession. However, physicians and scientific investigators have the same moral failings as the rest of our species. While we have moved beyond the atrocities of the Tuskegee syphilis "research," we are actively combating plagiarism, fraud, corporate misconduct and ethical erosion.

Most of us believe that our physician's exam room is a sanctuary from dishonesty. Our own doctor, while imperfect, is honest and would not knowingly give false information to us. A recent survey published in Health Affairs challenges this assumption and suggests that a new battlefront against medical dishonesty needs to be waged.

Nearly 20% of about 1,800 physicians surveyed did not soundly reject that patients should never be told a falsehood. About 10% admitted to having done so themselves.

We don't know the specifics of their truth-stretching, which may have been well meaning massaging of medical facts or sanitizing a prognosis. Nearly a third of physicians did not agree that medical errors should be disclosed to patients. Keep in mind that while patients have a right be informed about medical mistakes, the current medical malpractice system is a major impediment blocking physicians from admitting error. It's a little tougher for a doctor to tell a patient he messed up when this admission will be used as a legal cudgel against him.

I think that honesty is an absolute virtue, and not an elastic concept that can be stretched over questionable behaviors. How would I measure up? Here are examples of advice that I've given patients over the years:
--recommended fiber as a treatment for irritable bowel syndrome, although there is no scientific basis for this,
--ordered CAT scan for defensive purposes to minimize my legal vulnerability,
--placed feeding tubes in patients at the request of attending physicians when the medical benefit of this intervention is questionable,
--kept silent when patients were being subjected to overtreatment by me or my colleagues.

How do I reconcile my view that I am honest with the above examples? Are my honesty standards too high or is my performance too low? Although my level of honesty may be sufficient to practice medicine, according to the unnamed author of the quote that begins this post, it would surely disqualify me from the practice of law.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.