Is it ever OK to withhold information — or even to lie?

Last month’s report in Health Affairs generated headlines for at least a week. “Survey Shows That at Least Some Physicians Are Not Always Open or Honest With Patients” contained some eye-opening statistics that should definitely be taken seriously.

One third of the 1,800 physicians surveyed “did not completely agree with disclosing serious medical errors to patients, almost one fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one tenth said they had told patients something untrue in the previous year.”

These are all violations of professional and ethical guidelines. However, the study also notes that these are not necessarily black-and-white situations.

“For instance, providing a patient with every detail about his or her case is rarely feasible, nor is it necessarily desirable. Physicians must sort through often contradictory and confusing information as their clinical assessments evolve and finally crystallize. Conveying many details — some of which may be erroneous — to patients might not prove helpful.”

The study says that gravely ill patients prefer honest and accurate information. Yet some physicians avoid disclosing all the details to keep patients from losing hope.

“Especially in the context of life-threatening illness, physicians might not tell patients the complete truth because of lack of training, time limitations, uncertainty about prognostic accuracy, family requests, and feelings of inadequacy about their medical interventions.”

Most people about to go under the knife want to know all the details and for those patients, the study contains some reassurance.

“General surgeons were significantly less likely than physicians in most other specialties to report having told patients an untruth, and surgeons were significantly more likely than other physicians to agree with the need to disclose all medical errors to patients.”

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Shelley Slade
Vogel, Slade & Goldstein

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