Monday November 10, 2008
Lies and the Truth
On this week's all new episode of White Coat, Black Art, we reveal the lies doctors tell their patients, the lies patients tell their doctors, and the lies patients often ask their doctors to utter on their behalf.
Truth telling and lies are yin and yang in the doctor patient relationship. In the past, it was considered acceptable, even necessary, for physicians to lie to their patients. I'm reminded of the scene from the film "A Few Good Men" in which the character played by Jack Nicholson spits the iconic line "you can't handle the truth." There was a time when doctors believed patients could not handle being told they had an incurable illness and were going to die.
No doubt a great deal of the lies told by physicians are to protect themselves, and not their patients, from the mutual realization. To tell a patient they are going to die invites the patient to blame the physician. To me, another reason for self-serving lies is that we are so often wrong about our pronouncements. I can think of many occasions in which I or my colleagues told patients' families that a loved one was going to die, only to have the patient rally and even go home. Over time, experience teaches all physicians to be more accurate in our predictions. More important, it teaches us to hedge our bets...instead of being all knowing, to let life itself sort out the answers to our most profound questions.
Have we evolved in our practice towards more truth telling? You bet. Thirty years ago, surgeons had to inform patients such the risks of surgery that "a reasonably prudent surgeon" thought they should tell. Not good enough, said the courts. A new standard arose: patients were to be told the risks that "a reasonable patient would want to know". More recently, provincial colleges have issued guidelines that physicians must inform patients of adverse events. Some provinces have passed laws telling physicians to apologize for medical mistakes.
I believe that the overall effect of these developments is to increase the integrity of the doctor patient relationship. On the other hand, just because there is more truth telling in our mutual affairs, does not mean that the telling need be brutal.
Previous Comments (3)
I am sure some a number of patients are disillusioned. It is unfortunate you did not have a Margret Somerville on the show. It would have been interesting to hear her take on this subject. As a health care professional I think there is something inherently wrong with deception, patient or physician. Does this cost the system money. You bet it does. I think these issues need to be addressed if we are to move into collaborative practices to reduce confusion and provide better patient care.Garry King, November 10, 2008 1:20 PM
Patient's family asks you not to tell the ailing elder they're going to die-
I've been involved with that scenario and I agree with the interviewee on today's program; that my responsibility is ultimately to the patient and if he or she wants to know then I'd tell them. I would as he said first ask the patient "do you want to know what's wrong with you?" as an opener and go from there.
In my experience as a family doctor treating hospital patients I would say people know they're dying if they ARE dying, even when not yet told. With that in mind they'd know you're lying if did so. "Fooom" goes the trust when it's most important.
As one of the interviewees on the programme I hope my remarks weren't taken as a defense of deception -- I have written a number of papers defending honesty and veracity -- both are central to modern medicine. I was also trying to point out that sometimes veracity has a price and 'doctoring the truth' has a long history in medicine.Philip Hebert, November 20, 2008 5:46 PM