When Doctors Lie

Doctors and other health professionals should never lie.

We accept that as an almost sacred truth.  But reality suggests something quite different.  Doctors lying to patients – either by commission or omission – is both more common and more “ethically gray” than we might think. 

Sometimes, doctors lie out of a sense of altruism or patient protection.  They believe they need to shield a patient from hard truths, particularly if the patient is dying.  Sometimes, the doctor – accustomed to seeking a cure – is simply unable to accept that a condition is incurable, or that additional treatment won’t make a difference.

Sometimes, doctors lie for their own motives.  They may be seeking loopholes in the informed consent laws, or they may want to get patients to agree to a course of treatment that would be conducive to insurance reimbursement.

Some patients ask their doctors to lie.  They may want an HIV diagnosis left off their records (including their death certificate).  They may not want a doctor to report that an injury was the result of a DUI.  They may ask the doctor to change the date of a diagnosis to avoid pre-existing condition insurance traps.

Some families ask doctors to lie to patients (their loved ones).  They believe that Mom is too frightened or feeble to handle her diagnosis. 

Some doctors lie because the issues are ethically and morally complex.  A doctor may feel he needs to assure a patient that he’s chosen a great surgeon, despite knowing that the surgeon has a past history of substance abuse.

Are there occasions when a doctor should lie?  Or when an incomplete disclosure might be justified?  When a doctor is simply uncertain of a patient’s prognosis, should that be part of full disclosure?  More important:  who should decide the answer to these questions?

There are no simple answers because no two patients or families are the same.  Yet the enormous weight of evidence suggests that medical lies have harmful and often uncontrollable consequences.  When doctors decide to protect a patient, they may run afoul of the law (in not reporting true circumstances) or – more likely – they rob a patient of the autonomy to determine the right course of action for his life.  Doctors who protect patients from the severity of their own conditions -- even at a family’s impassioned requests – are denying the patient the opportunity to make important decisions about his treatment and his quality of life.  Far too often, this results in aggressive, prolonged, and ultimately counterproductive treatments simply because no one has compassionately and forthrightly spoken with the patient.  Even patient denial is not sufficient cause for lying (denial of the severity of a medical condition is often an early phase of coping).

It is also true that most medical training does not sufficiently help doctors and healthcare professionals communicate hard and sensitive truths to patients and their families.  It is hard to assess what a patient can emotionally bear; some of the strongest patients crumble at the prospect of surgery.  But emotional assessment is as essential to medical treatment as physical assessment.  Both are the physician’s responsibility.

If you suspect that a physician is not being fully honest with your loved one, there are a few steps you can take:

• Talk to your loved one and gently assess how much he really knows.  Many patients know far more about their conditions – and far earlier – than we (or their physicians) think.  On the other hand, no matter how much you know and love your parent, spouse, or sibling, their preferences, not yours, must be respected.  If a patient steadfastly refuses to hear the truth, that is something you must respect.  Be aware that your loved one’s views may change as a condition worsens, which is why continuing, clear communication is so necessary.
• Talk to the doctor.  Respectfully voice your concerns and your experience with what your loved one has indicated they know…or want to know. Listen to his response; he and your loved one may have had a discussion before this time concerning how to deal with specific situations.  Also, the doctor-patient relationship is a protected one unless the patient (your loved one) has signed a release that the person they have specified may be informed of the particulars of their condition.
• If you make no headway with the physician, speak to a nurse, social worker, caseworker, or hospital administrator.  Express your concerns clearly and respectfully and ask them to intercede. Be aware that the burden of proof is yours – proof that the patient wants to know the truth about his condition, and proof that the doctor has not been fully disclosing.