“Everything is going to be OK,” I told her while she was lying in a hospital bed. She presented to the ER for back pain, and the ER doctors had told her to lose weight. She came back the next day with blood in her urine, and after scans and a thorough assessment, she was diagnosed with renal cancer.
I didn’t know her prognosis, and honestly, I wasn’t sure if she would be OK, but I didn’t know what else to say.
Obscuring hard truths is still lying
Although this was not an intentional or blatant lie, it was, in fact, not the truth. We often tell these false truths to our patients because we want to give them hope, and we often don’t know what else to say.
"We do it out of compassion and to offer words to lighten our patients’ hearts in times of despair."
— Kristen Fuller, MD
Other common “lies” I have told my patients to lighten their emotional toll include, “Your breast milk will come in any day now,” and “Of course your baby will sleep through the night.” I couldn’t bear to tell those new moms, who were beyond exhausted and stressed, that these things may not have been true.
I have heard palliative care doctors say to loved ones who are on life support, “They can hear you when you talk to them,” and “No, they are not in pain.” I have heard colleagues say to mothers who delivered a stillborn baby at 21 weeks, “He is beautiful.” Are these truths? Well, not exactly.
Perhaps we also tell “compassionate lies” to our patients (and to ourselves) for our own sake, to spare our emotional toll, and to prevent us from breaking down in the call room overnight when we know the outcome will not be good.
We are upheld by a moral code, but we still lie
As physicians, we are held to a high moral standard to tell the truth to our patients, colleagues, insurance companies, and medical records.
“A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities,” notes the AMA in its Code of Medical Ethics.
Regardless of our motives or the depth of the lie, lying isn’t usually OK. Some physicians lie to third-party payers to have a procedure or prescription pre-approved and covered by insurance. Maybe they do this solely to benefit the patient or to collect payment for themselves, but regardless, it is a lie.
Other physicians lie to patients about their prognosis, keeping difficult information from them, or to describe their prognosis in a more positive manner than it is.
Some physicians keep medical errors from their patients out of fear of being judged or sued; others don’t disclose their financial relationships with drug and device companies to patients.
“Physicians tend to provide minimal information to patients after medical errors and infrequently offer complete apologies,” write the authors of an article in Primary Care Companion to The Journal of Clinical Psychiatry. The authors note that the majority of physicians cite litigation concerns, but that evidence suggests telling the truth can actually reduce the risk of adverse legal outcomes.
We don’t just lie to our patients
In residency, we often lie about our work hours. I am guilty of this, and I know my resident coworkers were, too.
Although we were told to work an 80-hour work week due to the duty hour rule, plenty of us were shamed when we logged over 80 hours, and therefore, regardless of how many hours we worked, we lied and fudged our hours so our program wouldn’t punish us.
Have you ever put WNL—within normal limits—in the medical chart on a rushed physical exam with a patient because you were short on time? Have you ever skipped parts of the physical exam but check the boxes on the EMR to meet the billing code requirements? Have you been told how to code “properly”—wink, wink—on billing to increase your revenues?
Have you ever lied on your state licensure application about your mental health out of fear of being reprimanded about your struggle with depression or anxiety? When someone asks you, “How are you doing?” have you ever responded, “Good,” despite this being far from the truth? I know doctors who drive over an hour away to seek mental health care because they fear losing their license or being put on probation.
Have you ever lied to an attending, colleague, or patient about knowing how to do a procedure when, in fact, you do not feel confident in your skills but don’t want to expose your shortcomings?
We don’t just lie to our patients; we lie to ourselves, colleagues, bosses, and so on. Even if we don’t lie intentionally, it is still not OK. While I consider myself an honest person, I have succumbed to some of these lies.
Why do we feel compelled to lie?
As physicians, we lie for many reasons, none of which are ethical. We lie to protect our patients and their loved ones, for financial gain, to avoid punishment when we are in the wrong, and to protect our reputation, ego, and career.
We are navigating a broken medical system controlled by insurance and pharmaceutical companies, and sometimes, to do what is best for our patients, we feel we must lie.
"While I still don’t believe lying is OK, I don’t think it makes us bad people or doctors."
— Kristen Fuller, MD
We owe it to our patients and their families to cite morbidity and mortality statistics so they can understand the numbers, even though the art of medicine calls us to shield them from unnecessary pain. We can and should deliver bad news honestly and compassionately. Maybe this means delivering it in chunks so they have time to digest and understand what they are hearing. We want to give patients hope, but protecting their emotional well-being while preparing them for the reality of their prognosis is a delicate balance.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.