When and Why Physicians Lie to Patients

Do your fellow physicians see in shades of grey or strictly in black and white when determining what to say and disclose to patients? 

A new survey, conducted by researchers at Massachusetts General Hospital and published in Health Affairs, asked nearly 2,000 physicians about their opinions and practices when interacting with patients. Among the questions posed, the survey asked physicians how they felt about telling lies and stretching the truth when treating patients.

Eleven percent said they had told patients something untrue in the previous year; fifty-five percent said they had disclosed a patient’s prognosis in a more positive manner than warranted.

Unfortunately, the study did not ask physicians why they engaged in or approved of lying, and it did not ask them to clarify the type or extent of lie made or approved of.

Dr. Lisa Iezzoni, the study’s lead researcher, told the Associated Press she suspects physicians who reported stretching the truth did so because they felt it would provide a patient with hope. However, she said, physicians need to communicate openly with patients so that patients can make informed healthcare decisions.

But is openness and honesty always the best policy for physicians to take when interacting with patients?

I suspect many physicians lie or stretch the truth not only to provide patients with hope, but also because of the real possibility that their lie or exaggeration will improve a patient’s health.

In that case, the end may justify the means, says Stephen Hanson, a physician assistant in Bakersfield, Calif., and a Practice Notes blogger.

“Honesty is almost always the best policy,” he said in an e-mail to Physicians Practice. “But I could see some hypothetical situations where telling the patient something untrue, or being more positive than is warranted, might be the best course of action and make no difference in the treatment of the patient and the outcome(s).”

A prime example of a lie that could result in improved patient care is placebo usage. Arthur Caplan, a bioethicist at the University of Pennsylvania, says placebos sometimes save patients money, reduce side effects, and reduce anxiety. Even though prescribing it may require a lie, he told Medscape, “I am not sure that it is always wrong.”

As a patient, I have no issue with a physician lying to me if he believes it will improve my health outcome. Better health is my objective, regardless of how it comes about.

Other interesting survey findings:
• Cardiologists and general surgeons were most likely to report never having told patients an untruth in the previous year.
• Pediatricians and psychiatrists were least likely to report never having told untruths. Internists and psychiatrists were more likely to say they had described a patient’s prognosis in more positive terms than warranted than anesthesiologists and general surgeons.
• Physicians who graduated from medical schools outside the U.S. or Canada were more likely to say that lying is never appropriate when treating patients.

What are your thoughts? Do you think lying to patients is ever appropriate? Why or why not?