Physicians, Nurses Draw Different Lines for When Lying Is OK

Marcia Frellick

January 31, 2019

Physicians are much more likely than nurses/advanced practice registered nurses (APRNs) to find lying to patients on some matters acceptable, according to a new Medscape poll.

When asked if it was ever acceptable to lie to patients about a medical error, for instance, 12% of physicians said yes, compared with 4% of nurses. Eighteen percent of physicians and 13% of nurses/APRNs said they were unsure.

In telling patients their prognosis, again three times as many physicians as nurses/APRNs said it was sometimes OK to lie (24% physicians answered that way as opposed to 8% of nurses/APRNs). The amount of uncertainty was about the same for both groups: 14% of physicians and 15% of nurses were unsure.

A psychiatrist who responded to the recent poll said while he generally agrees that honesty is the best policy and lying to cover up mistakes is never acceptable, "under certain circumstances, telling the truth may cause more harm than benefit to the patient. Sometimes an illusion you can live with is better than a truth you cannot live with," he writes.

An internist who commented said sometimes the line is murky between lying and wishful thinking.

"I've often been accused by surviving family members of lying about prognosis and giving them false hope," he commented. "My customary response is that doctors have hope too."

The 648 responses to the poll included 286 physicians and 362 nurses/APRNs.

Lie to Get Treatment or Reimbursement for a Patient?

The poll also asked whether it was ever acceptable to lie on behalf of a patient to get treatment approval or reimbursement — and that drew the highest positive answers for both groups: 29% of physicians said yes and 23% of nurses/APRNs agreed, though there was a fair amount of uncertainty (16% for physicians and 19% for nurses).

Responders Answer "Have You Ever …"

The poll revealed different percentages when respondents answered whether they had lied to patients under those circumstances.

Among physicians, 17% said they had lied to patients about a medical error; 14% lied to a patient about his or her prognosis; 26% lied on behalf of a patient to get treatment approval or reimbursement; and 45% said they had not lied about any of those things.

Among nurses/APRNs, 6% said they had lied to patients about a medical error or had lied to them about their prognosis; 10% said they had lied on behalf of their patients for treatments or reimbursement; and 62% said they had not lied about any of those things.

A pediatrician who responded to the poll was not surprised clinicians would lie. He wrote, "Nurses and physicians stretch the truth all the time, mainly to get needed services and prescription drugs for patients."

The poll followed Medscape's reporting that referenced a study of more than 630 residents from 22 specialties, which revealed that although the vast majority would tell the truth about medical error, 10% would either not disclose the truth or would defer to another physician.

Another study mentioned in the story, which included 1900 physicians across the United States, found that only 83% agreed that physicians should never tell a patient something that is not true, and only 66% believed that all significant medical errors should be disclosed to affected patients.

Additionally, 11% of physicians said they had told an adult patient or child's guardian something that was not true in the past year, and 20% had not fully disclosed a mistake to a patient because they feared litigation.

A Medscape poll in 2017 found that of 922 physician responders across specialties, "57% said lying to protect a colleague was never okay; 38% said it could be justified if it didn't harm the patient; and 5% said it could be justified even if sometimes it is not in the best interest of the patient."

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