Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Honesty between doctors and patients goes both ways

Stewart Segal, MD
Physician
September 28, 2011
164 Shares
Share
Tweet
Share

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.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Father and son, doctor and grieving family member

September 28, 2011 Kevin 1
…
Next

Doctors with great bedside manner can also provide great clinical care

September 28, 2011 Kevin 13
…

Tagged as: Patients, Primary Care

Post navigation

< Previous Post
Father and son, doctor and grieving family member
Next Post >
Doctors with great bedside manner can also provide great clinical care

More by Stewart Segal, MD

  • a desk with keyboard and ipad with the kevinmd logo

    I dream of practicing free medicine

    Stewart Segal, MD
  • a desk with keyboard and ipad with the kevinmd logo

    I have a problem and my problem is me

    Stewart Segal, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Click, click, click: How can I help you today?

    Stewart Segal, MD

More in Physician

  • America’s pain management nightmare: How the DEA shaped the opioid epidemic

    L. Joseph Parker, MD
  • The middleman dilemma in health care

    Anonymous
  • Why write? Physicians share their stories of healing through writing.

    Kim Downey, PT
  • A doctor struggles to provide mental health care in Appalachia

    Ryan McCarthy, MD
  • Physicians are burned out. Could entrepreneurship be a cure?

    Arun Mohan, MD, MBA
  • The dark role of science, medicine, and tasers

    L. Joseph Parker, MD
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • The synergy of AI and human intelligence in transforming health care

      Harvey Castro, MD, MBA | Tech
    • Post-pandemic nursing workforce challenges continue to mount

      Karlene Kerfoot, PhD, RN | Policy
    • Navigating physician shortages in rural communities

      Stacy Wentworth, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Post-pandemic nursing workforce challenges continue to mount

      Karlene Kerfoot, PhD, RN | Policy
    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • How to select the right mutual funds for your goals

      Amarish Dave, DO | Finance
    • America’s pain management nightmare: How the DEA shaped the opioid epidemic

      L. Joseph Parker, MD | Physician
    • The middleman dilemma in health care

      Anonymous | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Texas Emergency Medicine Residency Program Won't Shut Down
  • Recurrence Rate of Colorectal Adenomas Reduced With Endoscopic Submucosal Dissection
  • Very Early ART Can Result in Sustained HIV Suppression in Neonates
  • A Closer Look at the Approval of CRISPR/Cas9 Gene Therapy for Sickle Cell Disease
  • Teens' High BMI Tied to Early Chronic Kidney Disease

Meeting Coverage

  • In-Office Thermal Technology Superior for Dry Eye Treatment
  • ASCT Tops CAR T-Cell Therapy for Relapsed LBCL in Complete Remission
  • Frontline Venetoclax-Ibrutinib for CLL Boosts Survival in Fit Patients
  • Emicizumab Safe, Effective, in Infants With Hemophilia A
  • Add-On Inavolisib Ups PFS in PIK3CA-Mutated Breast Cancer
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • The synergy of AI and human intelligence in transforming health care

      Harvey Castro, MD, MBA | Tech
    • Post-pandemic nursing workforce challenges continue to mount

      Karlene Kerfoot, PhD, RN | Policy
    • Navigating physician shortages in rural communities

      Stacy Wentworth, MD | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Post-pandemic nursing workforce challenges continue to mount

      Karlene Kerfoot, PhD, RN | Policy
    • Catastrophic failure of educational leadership can affect medical students

      Arthur Lazarus, MD, MBA | Education
    • Unraveling the mysteries of mast cell disorders [PODCAST]

      The Podcast by KevinMD | Podcast
    • How to select the right mutual funds for your goals

      Amarish Dave, DO | Finance
    • America’s pain management nightmare: How the DEA shaped the opioid epidemic

      L. Joseph Parker, MD | Physician
    • The middleman dilemma in health care

      Anonymous | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Honesty between doctors and patients goes both ways
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...