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On Being a Doctor |

Lies to a Patient

Abha Agrawal, MD
[+] Article and Author Information

From Kings County Hospital Center, Brooklyn, NY 11203.


Requests for Single Reprints: Abha Agrawal, MD, Kings County Hospital Center, 451 Clarkson Avenue, Suite 1147, Brooklyn, NY 11203; e-mail, agrawal.abha@gmail.com.


Ann Intern Med. 2008;148(9):707. doi:10.7326/0003-4819-148-9-200805060-00012
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It was another routine afternoon in my office practice. My next patient was a 51-year-old woman, Mrs. K., presenting for an annual physical examination and a Pap smear.

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Lies are never a good option
Posted on May 14, 2008
David R Fulp
No Affiliation
Conflict of Interest: None Declared

I understand the short term benefit of your "lie" but if your patient ever found out the truth the great relationship you built will be forever ruined. Their will be no trust in a person who lies. I have always found that if the patient could not deal with the truth of any situation they and you are better of separating. You said it in your article, where does it end?

Conflict of Interest:

None declared

It's Never Easy
Posted on May 22, 2008
Dean Blakeley
No Affiliation
Conflict of Interest: None Declared

Being a gay male with a life partner of over 13 years, it's an awkward situation that I've struggled with on various levels. When I was confronted by a colleague about still having internalized homophobia, I was incredulous. After it was clarified, I agreed that he was probably right. The difficulty in sharing things like that is all in the context. Clearly it would have been awkward because the patient was already in a situation which could have gone bad in a heartbeat. I always felt it could be misconstrued if it somehow came out during a prostate examination that I was gay. If there was really any worry, then having a chaperone always helps to diffuse things like that.

Sure, you missed a situation about being truthful. And, in time, I've had to correct some peoples misconceptions. My feeling is that it boils down to a transferrence reaction on the part of the patient which can detract from the clinical role at hand. I don't volunteer much because I find it's a distraction which erodes into the time needed to deal with a number of complicated medical problems. If they ask, I remind them that I have a fiduciary responsibility to focus on them, not me. One can argue that the patient is looking for cues that will help them feel comfortable with me. I try to accomplish this by clarifying their medical conditions and not my personal life.

It's an interesting balancing act to say the least.

Peace

Conflict of Interest:

None declared

Necessary lies in the clinic
Posted on May 25, 2008
Liu Hong
Institute of Digestive Disease, Xijing Hospital, Fourth Military Medical University, Xi¡¯an, China
Conflict of Interest: None Declared

To the editor:

We read with great interest the excellent paper by Agrawal A (1). It is generally believed that doctors should not tell lies to patients. However, some lies are necessary for the treatment of patients.

We have admitted a 67-year-old man, who was diagnosised as colon cancer. He was very worried about himself, and always asking the doctor the same question, "when will I die?" Unfortunately, he received an operation, which failed to have the cancer tissues eradicated. Then he was too afraid to have any food or drugs. We tried our best to comfort him but failed to make him drink or eat. Therefore, we told a lie to him, "combination of some new drugs can cure you." Finally, the lie had his mind changed and he began to have food and receive therapy. In our opinions, the lie is necessary for the benefit of the patient. We do believe that the patients will not mind the lies that bring them hope.

References:

1 Agrawal A. Lies to a Patient. Ann Intern Med. 2008;148(9):707.

Conflict of Interest:

None declared

Personal situation
Posted on May 30, 2008
David M Lewis
No Affiliation
Conflict of Interest: None Declared

I enjoyed this article by Dr Agrawal, but remain concerned about half -truths and outright lying to patients. What we do in our personal lives really should have no part in the consultation.

Unfortunately I have been away from my practice for eight months due to critical illness following bypass surgery in September 2007. My patients have missed me. Now I am returning many consultations begin with 'How are you, doctor?'

It is difficult for me to reply honestly because my role is to be 'the doctor'. Most of my patients are not really interested to learn of my chronic lung disease, physical infirmity and generalised anxiety with post-traumatic stress disorder. Nor do they wish to hear about my constant aches and pains and interrupted sleep pattern since January. But these are important to me and sometimes I feel that bits and piences of my frailty should be shared.

However, one patient booked an appointment with me specifically to check on me and reassure me that he has never felt better since his bypass 24 years ago. He was surprised and grateful that I wished to discuss his cholesterol treatment; perhaps I was a little too dismissive of his overture to help me.

Trust is something we must earn - outright lying to our patient cannot be a good thing. However, being economical with the truth need not betray that trust.

Conflict of Interest:

None declared

Lies to a Patient
Posted on July 22, 2008
Abha Agrawal
Kings County Hospital Center, Brooklyn, NY
Conflict of Interest: None Declared
I agree that physicians must be truthful to earn the trust of their patients and that trust is the bedrock of a healthy physician-patient relationship. This precisely is the reason for my distress with the patient interaction I described. However, the issue of patient and physician perception in regard to sexual orientation is complicated. A 1994 national survey of gay / lesbian physicians revealed that 67% felt they "would jeopardize their practices if their colleagues learned they are lesbian, gay, or bisexual" and 75% felt they "would jeopardize their practices if their patients learned they are lesbian, gay, or bisexual" (1). At least two further studies of patients' attitude on this issue seem to support this apprehension on part of physicians. Lee et al describe in their "Dilemma of Disclosure" study that of the 502 patient respondents in a national survey, many indicated they would change providers if they found out their provider was gay/lesbian (30.4%) or would change practices if gay/lesbian providers were employed there (35.4%) (2). Another study, published in 1998, found out that 11.8% of respondents would refuse to see a gay/lesbian physician "“ the most common reasons being fears of incompetence and worries about feeling "uncomfortable"(3). Estimates suggest that there are several hundred thousand gay/lesbian providers in the USA. Therefore, this issue has the potential to impact many patients, families, and their providers. I hope my essay, your letters, a continuing dialog, and further studies will foster greater understanding among patients, physicians, communities, and society in regard to this issue. (1) Schatz B, O'Hanlan KA. Anti-gay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay, And Bisexual Physicians. San Francisco. CA: Gay and Lesbian Medical Association: 1994. (2) Lee R, Melhado TV, Chacko KM, White KJ, Huebschmann AG, Crane LA. The dilemma of disclosure: patient perspectives on gay and lesbian providers. J Gen Intern Med. 2007;23(2):42-7. (3) Druzin P, Schrier I, Yacowar M, Rossignol M. Discrimination against gay, lesbian, and bisexual family physicians by patients. CMAJ. 1998;158:593-7. Conflict of Interest:

None declared

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