Truth-Telling

KevinMD has a great guest post by Dr. Neil Baum which examines the ethics involved when a patient says one thing in front of family members, but says something different in private.  The discussion in the comments section has been pretty lively.  One comment, in particular, caught my eye.  Dr. Dave Miller says:

…“truth-telling” is considered to be one of the core tenets of medical ethics. Physicians are expected to tell the truth, even when it’s not convenient. Patients come to them in vulnerable positions. For a physician to tell less than the truth is to violate the trust implicit in and critical to the therapeutic relationship.

Once a physician starts telling “white lies” (however well-intentioned they may be) they are compromising their integrity. If a doctor is willing to lie about one thing, will they not lie about another? As a patient (or a family-member or a colleague) how can you know when a doctor is telling the truth or lying once the pattern is established? Would *you* like to be in the position of having to guess when *your* physician is telling *you* the truth or not? Hence, the best approach is for the physician to simply tell the truth.

Bingo!

At age 9 my daughter started having unusual symptoms.  Fatigue was first.  No cause identified, no solution.  Sore hips came next.  No cause, no treatment, no solution.

Symptoms progressed.  Finally, after a few years, I discovered her real concern.  I have Raynauds… my daughter has Raynauds.  I have RA… my daughter was afraid she’d end up with RA, too.

The next time the pain from her hips was so extreme that she was vomiting, I insisted that she see the doctor again.  I told him her concern – that this meant she was going to get RA, too.

I’ll never know why he responded the way he did.  He thought a minute, then looked at her with compassion and said, “You’re kinda young for that, don’t you think?”

  • Maybe he was trying to alleviate her fears.  I hate to think that he might have lied to make her less worried, but it’s a possibility that creates exactly the problem that Dr. Miller mentioned.
  • Maybe he knew the options and tried to stand on technicalities.  Technically, he was accurate in saying that she’s too young to get RA, because children are never labeled with RA; when kids get this disease it’s called JIA.  If this was his thinking, it was dishonest to lead her to believe that her age let her off the hook.  Slight twist, but this is really the same problem.
  • Maybe he didn’t know much about autoimmune diseases and really thought she was too young.  Nobody can know everything, and I wonder if we just happened to hit one of the areas he wasn’t as knowledgeable about.  If so, he was wrong.  Autoimmune arthritis can strike at any age – even infants.  There’s a problem with this option, too, but at least it isn’t one of integrity.

Since that long-ago appointment, I know (based on other conversations we’ve had), that our doctor has learned more about RA.  That gives me hope that his response to my daughter was due to ignorance, not dishonesty.  When we went back again, he dug deeper, realized how big the problem is, and started pushing for answers for my daughter.  He didn’t blow us off.  He’s learning, and helping.

If I was convinced that he had willfully lied, we would find a different physician.  I believe he’s honest, though, and wonder if this was a fluke, or if he just didn’t know that kids can get arthritis.

Unfortunately, the fact is that what he told my daughter was not the truth.  I don’t know why, and there will always be a little part of me that wonders if he’d ever try to minimize something else to keep us from worrying.  Dr. Miller is right.  It only takes one small incident.

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Edit to add:  Dave Miller writes that he is an MS3 – still working on that MD.