Doctors Not Always Open, Honest With Patients, Survey Finds

You trust your doctor to deliver all the facts, right?

Well, perhaps you should think again.

According to a just-published survey of more than 1,800 practicing physicians, a good chunk of doctors aren’t telling the full truth about various aspects of your medical care.

Specifically, about one-third of the survey respondents didn’t completely agree with disclosing serious medical errors to patients because they feared a malpractice case; two-fifths did not completely agree that they should disclose their financial relationships with drug companies to patients; and over one-tenth said in the past year, they’d actually told patients something that wasn’t true.

And this is happening despite doctors’ widespread endorsement of a set of guidelines called the Charter on Medical Professionalism, which requires “openness and honesty in physicians’ communication”.

“Our findings raise concerns,” write the study authors, led by Lisa Iezzoni, a physician and professor of medicine at Harvard Medical School, “that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.”

The new research, published in the February issue of the journal Health Affairs, has some limitations: There were only nine questions about physician communications with patients, and researchers were unable to ask follow-up questions.

Still, says Iezzoni, who also directs the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston, the whole notion of patient-centered care — which is, of course, all about transparency and empowering patients — is threatened without a basic foundation of honest discourse in the medical arena.

Of course, one can easily imagine circumstances where it might seem appropriate for doctors to withhold the full truth from a patient — in delivering a grim prognosis, for instance. The physician might believe this is the most humane path. (In this survey, 55% of physicians said they might put a positive spin on a prognosis in order to make people feel better or so they wouldn’t lose hope.)

But Iezzoni says those good intentions might undercut patients’ wishes. She cites cancer research in which patients do want to know exactly what their prognosis is even if it’s bad: they might need to write a will, or have important conversations with family members.

Other provocative, but not fully fleshed out, data emerged from the survey. For example, Iezzoni said that women and underrepresented minority physicians were a lot more likely to follow the Charter’s guidelines than white male physicians. Why? “Our speculation,” she said, “is that women and underrepresented minorities have only [fairly] recently joined the profession as full members, and because they are the new people, they have to be extra scrupulous to maintain their professional stature.”

Also, the paper says, “cardiologists and general surgeons were most likely to report never having told patients an untruth in the previous year, while pediatricians and psychiatrists were least likely to report never having told untruths.” One possible reason, said Iezzoni, is that cardiologists and surgeons “do invasive procedures that require formal informed consent, so they’re just a lot more likely to be open about complications…with patients.”

Other findings, plus a look ahead, from the news release:

More than a third of physicians did not completely agree that they should disclose all financial ties with drug and device companies to patients, even though such ties can influence treatment. The authors point out that such information will soon be available to the public as a result of provisions in the new health care law.

As these and other provisions of the Affordable Care Act are implemented, physicians will be under increasing pressure to communicate honestly and effectively with patients, says Eric G. Campbell, associate professor of medicine at Harvard Medical School and the director of research at the Mongan Institute. Yet the survey clearly shows that some physicians have trouble accepting and living up to the tenets that underlie patient-centered care, says Campbell, who served as principal investigator on the survey and was a coauthor of the Health Affairs article.

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