Honesty Is a Sometimes Policy for Many Physicians

February 08, 2012

February 8, 2012 — Roughly 1 in 10 physicians admits to having lied to a patient within the previous 12 months, and 35% do not completely agree that they should tell patients about their financial relationships with drug and medical device companies, according a study published in the February issue of Health Affairs.

These and similar findings about physician honesty "raise concerns that some patients may not receive complete and accurate information," write lead author Lisa Iezzoni, MD, and coauthors, who present data from a 2009 survey of almost 1900 physicians.

To medical ethicist Linda Emanuel, MD, PhD, from Northwestern University in Evanston, Illinois, the survey results represent a "welcome wake-up call" for her profession.

The study "is an indication that our medical culture needs a recess," Dr. Emanuel told Medscape Medical News. "We need to do some serious interventions to return to our ethical values.

"I don't think there's any situation where a physician is justified in telling an untruth."

The study attempted to determine how closely the medical profession adheres to the Charter on Medical Professionalism, which sets forth standards on physician honesty and openness with patients. The charter received the endorsement of more than 100 professional groups and the Accreditation Council for Graduate Medical Education.

Roughly 83% of the survey respondents completely agreed with the statement that physicians should never tell a patient something untrue. The rest either agreed somewhat or disagreed. When it came to actual ethical performance, 11% said they had told a lie to an adult patient or a child's guardian in the preceding 12 months, and 55% said that they had described a patient's prognosis in a more positive manner than was warranted.

Two thirds of respondents completely agreed that physicians should disclose all significant medical errors to affected patients. In practice, 20% said that they had not fully disclosed a medical mistake to a patient in the last year because they were afraid of being sued.

The reluctance to tell patients about errors is a symptom of a medical liability system that "puts physicians in a terrible bind," said Dr. Emanuel. "It's not just a matter of cultural or personal fiber. It's the way the system is designed." Dr. Emanuel noted that early and full disclosure tends to make patients less likely to sue, a point emphasized by the patient safety movement.

Women, Minority Physicians More Prone to Embrace Truthfulness

In their article, Dr. Iezzoni and coauthors report that honesty and openness among physicians vary on the basis of demographic factors, specialty, and practice setting.

Women and underrepresented minorities in medicine are more likely to follow the principles laid out in the Charter on Medical Professionalism. Roughly 86% of female physicians, for example, fully agreed that they should never tell patients something untrue compared with 81% of male physicians. In addition, female physicians (8%) were less likely to report telling a lie to a patient than their male counterparts (13%).

The authors surmise that in a field historically dominated by white men, women and minority physicians "may feel more compelled to comply with articulated professional concepts" to avoid any attitude or behavior that jeopardizes their standing. Dr. Emanuel added that the tendency of female physicians to be more "relationally oriented" may make it more comfortable for them to level with patients.

Cardiologists (96%) and general surgeons (94%) were most likely to say they had not lied to a patient in the past year, whereas pediatricians (85%) and psychiatrists (86%) were the least likely. Physicians practicing in medical centers or universities (78.1%) were more likely to completely agree with the imperative to disclose serious medical errors than physicians in solo or 2-person practices (61%).

More research is needed to understand the specific reasons why physicians fail to fully support the communication principles contained in the Charter on Medical Professionalism, according to the authors.

"Examining circumstances in which physicians feel justified in not complying fully with charter precepts is especially important," they write.

The Institute on Medicine as a Profession at Columbia University provided external financial support. The authors have disclosed no relevant financial relationships.

Health Affairs. 2012;31:383-391. Abstract


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