Remember, too, that honesty and an emphasis on the positive are not mutually exclusive. "You need to focus on what's important about their condition, but there is an art to presenting things to people in different ways," says Dixon. "You can give bad news but put a positive spin on it. When patients come to me with a spot on their liver from an X-ray, their primary-care doctor has already told them they have cancer. When they see me, I can say, well, 98 percent of your liver looks great."
When faced with family members who wish to shield their aging parents or grandparents from a poor prognosis, Dixon says he simply levels with them. "I don't think that's fair to the person who is sick," he says. "I express my opinion, that I'm not comfortable with hiding things. You don't have to go into explicit detail [about their fragile state] and you can be more general, but I tell them to put themselves in the patient's shoes and think about what they would want."
Though doctors in private practice rarely encounter such scenarios, physicians who work in a hospital setting may also be asked by the friends or family of an accident victim to delay information about another passenger's death until a parent can break the news. In those cases, says Berlinger, it's a judgment call. "It would have to be clear how long we're talking about — an hour or four days, because if it was several days that might be tantamount to deception," she says, noting this is a case where a hospital ethics consult can assist. "It's about the information, but it's also about providing support to a person who is getting bad news. It's a very stressful situation and they need to feel continuity of care — that someone, like a nurse, their doctor, a chaplain, or a family member, is sticking with them and attending to their emotional needs."
Whatever your motivation for being less than truthful with patients, Berlinger says, there is really never good cause to keep patients in the dark. "If a doctor is considering withholding information, the first thing they have to ask themselves is why would I do this — given my obligation to disclose information to my patients and their right to information about their own health?" she says.
For most patients, full disclosure about their condition takes fear off the table. "One of the problems is that physicians don't level with people and discuss openly what happens next and what to expect — what you're going to feel like," says Dixon. "When people are prepared they're not afraid anymore."
Treating patients is a complex business. Sometimes you have to have tough conversations with patients about their diagnoses. Is it ever appropriate to spin the truth or withhold information from a patient? Consider the following:
• In most states physicians are legally obligated to disclose all relevant health information to patients.
• Is it more compassionate to patients to withhold upsetting details about life-threatening diseases or to give them the comfort of knowing the truth and making their own decisions about the end of their lives?
• Physicians should examine their motive for withholding information: Is it compassion, fear of the time it takes to have more involved discussions, avoidance because it's hard to deliver such news, or something else?
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and in Healthy Family magazine. She can be reached via [email protected].
This article originally appeared in the November 2010 issue of Physicians Practice.