Is Honesty the Best Policy? Many Doctors Don’t Think So

It is generally accepted by doctors that being honest with patients is the best approach. Unfortunately, not all physicians agree, according to a survey whose results are published in the February 2012 issue of Health Affairs.

The study revealed that 33% of doctors who were asked – about 630 – did not agree that they should tell patients when there was a medical error in their treatment.

40% said they did not agree they should disclose their financial relationships with drug and device companies to patients. 10% said that, in the previous year, they had told patients something that was not true.

Dr Lisa Iezzoni

Care to see a healthcare hero at work? Meet Dr Lisa Iezzoni

 

The findings certainly reflect poorly on the healthcare facilities that brag about being “patient centered” and “focused on the needs of patients,” says Lisa Iezzoni, a physician herself, as well as a professor of medicine at  Harvard Medical School. “Patients who do not get the full story might not make an informed choice about the best course of action for their care,” Iezzoni says.  “Until all physicians take a frank and open approach to communication, it will be very difficult to enact patient-centered care more broadly.”

Iezzoni and her colleagues surveyed 1,900 doctors nationwide to learn if they were following proper standards of communication, as defined by the ABIM Foundation’s Charter on Medical Professionalism. That landmark document, published in 2002, urges physicians to be open and honest with patients and to disclose medical mistakes immediately.

Although it’s true that most doctors agree physicians should inform patients about the risks of treatment, a large number admitted  they themselves were sometimes dishonest with patients.

Consider that 20% of them said they had not fully disclosed a medical mistake to a patient in the previous year because admitting the error would trigger a legal action. These doctors are out of touch with the real world. Research shows that prompt admission of mistakes  reduces anger and makes patients less likely to pursue a lawsuit.

Other important findings from the survey are as follows:

  • 56% of physicians said they often or sometimes described a patient’s prognosis in a more positive manner than the facts support. Physicians often rationalize this practice by saying they do not want to upset patients or cause them to lose hope. However, studies suggest that most patients do want to be told the truth, even if the outlook is dire, so that they can make the best possible decisions under the circumstances.
  • Women and under-represented minority physicians were significantly more likely to follow the Charter’s provisions on honest communication compared to white male doctors. The authors note that women and minority physicians have entered a field that historically has been dominated by white males. Women and minority physicians might feel compelled to rigorously adhere to standards of professional behavior, the authors say.
  • 35% of physicians did not agree they should disclose financial ties with drug companies to patients, even though such ties can influence treatment.

As these and other provisions are implemented, physicians will be under increasing pressure to communicate honestly and effectively with patients, says Eric G. Campbell, associate professor of medicine at Harvard Medical School.  Yet the survey clearly shows that some physicians have trouble accepting and living up to the tenets that underlie patient-centered care, says Campbell, who served as principal investigator for the study.

 Here’s more:
– the study abstract
– the Health Affairs blog post

 

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