Honesty between doctors and patients goes both ways

Yesterday, someone asked me, “Can I be perfectly honest with you?”  I wanted to reply, “No, just be dishonest, I like it better that way!”  “Can I be” implies that, in past conversations, my patient has been dishonest.  Dishonesty is a relationship breaker.  Dishonesty leads to distrust and if I cannot trust what a patient is telling me, I cannot be effective; the doctor-patient relationship is terminated.

Am I being too harsh?  Are there degrees of dishonesty that are acceptable?  While there may be a place in the real world for partial truths and degrees of honesty, there is no room for dishonesty in the exam room.  In June of this year, I published “Three Things” an article about the importance of being honest with your doctor and being honest with yourself.  When surveyed about the three most important things a doctor can tell his/her patients, the most common theme was to be honest.  Don’t lie.

Today was one of those days.  A second patient admitted that, when he saw me on Friday, he was not honest with me.  His condition had worsened dramatically, the pain making him regret not haven’t been “perfectly honest”.  Both patients had their own reasons for hiding the truth.  There are many reasons patients exercise various degrees of honesty.  Some patients feel their actions make them look foolish; some fear the doctor’s scorn, some fear the answer to their problem will be too much for them, others are simply embarrassed.  No matter what the reason, the doctor-patient relationship should be a partnership based on mutual trust and respect.  In a relationship of trust and respect, there is no place for dishonesty.

Unfortunately, it’s a two way street.  There are times when I want to be less than totally honest.  There are times when I want to “soft sell” the truth, knowing that the truth is going to hurt.  After all, my job is to heal, not to hurt.  Nonetheless, if I shelter my patient from the truth or mislead him, I break the relationship of trust and respect.

There are other times when family members ask me to spare their loved one the horrors of a bad truth.  They want to lessen their loved one’s (my patient’s) pain and suffering.  Telling the truth, the whole truth, can be a real problem.

So, what to do?  Risk the relationship of mutual trust and respect to spare someone pain?  Then what happens when your patient needs honesty and discovers your deceit?  It’s not an easy choice.

We are all humans, striving for the impossible goal of being perfect.  The doctor-patient relationship is as imperfect as the two people who make up that relationship.  Each has to recognize the other’s imperfection.  Each has to strive to be “perfectly honest”.  Each person has to realize how difficult it is to be “perfectly honest”, and that honesty can save a life, can take a life, and can hurt!

I have chosen the path of seemingly brutal honesty, pulling no punches, for the vast majority of my career.  I think people deserve the truth and that my job is to preserve the trust in the doctor patient relationship.  There have been times when I have regretted that choice.

I hope my patients will choose the honest approach, no matter how difficult that choice.  I hope they will understand how important knowing what is truly happening to them is and how the truth will ultimately impact their diagnosis and the success of treatments.   I hope they recognize that the life they save may be their own.

I also hope that they will forgive me when I tell them what they didn’t want to hear, what hurts.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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