The simple answer would be No, but few things in life are as simple as they appear to be, and I think a more thoughtful reply would be - Yes, sometimes.
In fact, the distinguishing mark of a senior doctor is that he knows how to lie - and when to do so. This is not something which can be taught or written down, which is why it is a sixth sense which is acquired by experience. I am sure all senior doctors will agree that they have lied for their patients' good during their career - and anyone who does not agree with this is telling a much bigger lie.
Is it ethical to lie ? This is a hard call. It's much easier to just tell the truth all the time - but there are times when hiding the truth and lying is in the patient's best interests. Good doctors know this - and will use a lie as a valuable therapeutic tool, when they feel that the truth would harm their patients.
Am I suggesting that we return to the "good old days" when the "doctor knew best" and cancer was a word which was never discussed openly. Of course not ! I am a big believer in patient autonomy and the patient's right to know . However, in clinical practise, there are situations when the patient does not want to know the truth ; and times when the truth can actually be harmful. Some patients what their doctor to shield them from the truth, and good doctors can sense this . They know when to hide the truth; and from whom.
This is not an easy skill to acquire, and requires reflective contemplation and practise. It's a privilege which can easily be abused by a bad doctor, but a good doctor can use a lie ethically , if he does so in order to help his patients .
With regard to revealing pertinent medical information to the patient, I would disagree and say that doctors should not lie. In fact, lying goes against the fiduciary responsibility a physician has for a patient to establish and maintain trust. I doubt lying will ever be found to be therapeutic in the long run.
ReplyDeleteTo me, I think the skill of the physician whether senior or not is the skill the doctor has to tell the truth. Telling the truth (the facts and the advice) is not an all or none action. There has to be an understanding by the physician regarding the education, emotional state and the wishes or requests of the patient.
With that understanding, the physician can "tailor" the explantion to the specific patient. "Tailoring" doesn't mean lying. "Tailoring" means revealing the whole truth in a manner which can be digested, understood and accepted by that patient. Often, the patient does not need to know the entire story in all of its details at once. How much the doctor tells depends on what the patient wants to know. How the doctor tells the patient is based on the feedback during the conversation with the doctor learning how the information is being accepted. This takes skill and patience on the part of the doctor. But eventually, in one way or another, the whole story is told. Of course, in some cultures different than the standard "American" medical culture, it is wrong for the patient to be told the truth. It is considered harmful so that only the family or community is to be infomed. This poses a conflict with most American physicians facing this issue, especially in an environment requiring patient autonomy and legal informed consent. Anyway, thanks to Dr. Malpani for presenting this interesting topic. ..Maurice.
I had a psychiatrist when an inpatient, he filled in a form for me to get a disability pension then said I could go home that day, but he deliberately sabotaged my application. Unknowingly I submitted this application and 6 months later, new psychiatrist (med's more than doubled now), this application is still being used to deny me a pension even though my new psych fully supports me. My old psychiatrist lied to me then discharged me on 150 mg's anti-depressants when I should've been on 375 mg's plus Serequal and Valium. Male doctors hate fat chicks.
ReplyDeleteMy Doctor lies all the time. I have no idea why. He told me he was going to be away for 17 days but when I phoned reception to see another Dr to get my blood test results, I discovered he was there that day!! Apparently he's doing exams and is in/out all the time. oh! really! Funny, I'm simply told "I'll be away". I still don't have a print out of my blood test results, I'm simply told my sodium level is low. blah blah blah!!!! I give up!!! He expects me to be honest, so why can't he be?
ReplyDeleteOn a continual basis his reception is over riding what he tells me in the surgery as to when he is available. Perhaps this Dr doesn't want me as his patient, why the hell then doesn't he tell me? I am a pycho patient, suicidal and he's already told me I am difficult, my problems aren't of any great nature, yet he doesn't know the extent of my problems nor has he taken a full medical history on me. I have been totally honest with him in regards to what I'm doing, but.........say no more. Unreal!!!!!!
I can only agree, what an interesting subject. I suppose this then can bring up the subject as to why Doctors laugh at you when you tell them the truth? Right!
Is it legal for a doctor to lie and tell the adult daughters of a man that he is brain dead when he is clearly not (he was sitting up and smiling and communicating with hand gestures 15 minutes after the doctor told us that our father had "nothing neurologically going on and he is only responding to pain stimulus.") His wife (of five years and not the mother of the daughters) wanted to take the individual off the ventilator prematurely?
ReplyDeleteHaving worked in the medical system at clinical professional level I can tell you some things. I have seen doctors lie, I have seen nurses cover up for them by phoning them at home asking them to go back to work to change a medication he charted because the patients body systems were shutting down, and as soon as they die nobody can have access to the records. I have seen medical staff exploit patients in the psychiatric sector, I have seen them gang up and destroy each other and I have the written evidence of mind-games at CEO level, I just remembered it with PTSD I'd had amnesia about it for four years. They ganged up on me because I blew the whistle at management level so they had to cover up for each other and discredit and dispatch the evidence. I'm now PTSDing in a very big way as I relive the facts while I am going through an insurance claim against that gvt dpt's insurance company because I am totally and permanently disabled. Top That!
ReplyDeleteFrom a bioethic view, I'd say that the doctor should first and foremost respect their vow "first do no harm". Doctors make their decisions based on that vow, and there are all shades of grey here.
ReplyDeleteFrom my own bioethic view, as a former student of bioethical philosophical foundations, as as a retired clinician my interpretation of that vow would say whatever I felt and believed in that day.
Why blame the doctors? They only have to follow the rules, and not all rules apply to any legislation.
I have had a cancer surgeon put into his report. That I had unreasonable expectations. That I wanted a 100% guarantee he could get all the cancer and to be guaranteed that there would not be any nerve damage. The truth is I believed that the cancer was inoperable. The only question I had was how much damage to expect. I didn't even ask if he thought he could get it all. Any chance was better than what I had. I did ask how much nerve damage to expect. Yes. Doctors definitely lie. And sometimes without any reason. I have cancelled the surgury until I can find out why.
ReplyDeleteSometimes there are miscommunications between doctors and patients/families/other health professionals. I have also witnessed doctors being genuinely surprised when a patient has 'risen from the dead' or suddenly recover miraculously. As a retired health professional I have even got my patients mixed up sometimes.
ReplyDeleteI think communication is a great tool when dealing with any professional. Take notes, read them back to the doctor for confirmation etc. Remember that doctors can not read your mind, they prefer clear questions and answers because many times either you or the doctor could be unintentionally ambiguous or indirect.
One of my doctors blocks off days when she is studying or teaching, yet she is in and out of the office. But she is unavailable for me and her other patients, and that is her right.
I was just wondering if anyone knew if a psychiatrist would lie for a patient if the patient asked them to? Not legally speaking but to family members
ReplyDeleteI've known medico-legal psychiatrists lie to their employer ... insurance companies who do pay a lot of money to hear what they want to hear. And I have written evidence of this.
ReplyDeleteLying to a patients family should never be an issue because the psychiatrist's oath 'first do no harm', which doesn't apply to psychiatrists on insurance pay-rolls, certainly applies here. No. It is never ok for a psychiatrist to lie, and they don't have to. A patients family or employer or The 9 O'clock News is only given information that the patient has approved of. If the patient has lied to the psychiatrist then the psychiatrist can not be held to account because they were misinformed, deliberately.