Sunday, May 19, 2013

Do Physicians Lie?

Yes.  Professions that heretofore enjoyed public admiration for pursuing noble work and reputedly insisting on the highest ethical standards have been exposed.  The Catholic Church could write a few blog posts on this.   Police officers, journalists and even teachers have also shown us that they are members of the human species and are subject to its weaknesses and frailties.

George Washington Cannot Tell a Lie

The fallacy is to expect certain professions and professionals to be more irreproachable than the rest of us.  We are all vulnerable to experiencing a fall from grace.  Staying straight and true is a struggle, at least for me. 

Yes, physicians lie. 

Sometimes, we rationalize a falsehood because it serves a patient’s interest.  We 'adjust' a diagnosis so that the medical test is covered by insurance.  Explain to me please why this is not stealing?  Is this different than shoplifting?   Why should the offense change depending upon who the victim is?   Many folks believe that stealing from the phone company or insurance companies isn’t really stealing.

Sometimes we physicians massage the truth in order to sanitize a grim prognosis.  While I’m not ready to brand these physicians as liars, this tactic falls somewhat short of the truth.  I have been culpable of this.  It’s not as easy as it sounds to get this right.  How much information do we divulge?  Does it all need to come out in the first conversation?   Are we always so sure that the patient before us won’t respond to treatment, even if the medical data suggests an ominous road ahead?    How many patients have we heard of whom were told they had 6 months to live and proved the doctors wrong?   How did these folks feel each day they woke up beyond the 6 month marker? 

This past week, I heard of a physician whopper that broke the record.  A consultant was asked to see a patient in the hospital.  This patient already had an active relationship with a different consultant in the same specialty. ( If a cardiologist, for example, is asked to see a patient in the hospital and discovers that the patient already has a cardiologist, the first cardiologist should step aside and notify the patient’s true cardiologist that the patient needs his medical services. This act would be included in the category called, Doing the Right Thing.) When this consultant greeted the patient, she asked to see her own consultant and even presented her own consultant’s business card to the doctor.  The physician told the patient that her consultant did not have attending privileges at the hospital and did not even perform the procedure that was being contemplated.  Both of these assertions were demonstrably false.  After the patient was discharged and followed up in the office with her consultant, the matter was exposed.  The patient has filed a grievance.

Of course, there are rogue elements in every occupation and institution.  We should not permit an entire profession to be sullied by aberrational behavior.   Sure, some teachers have helped students cheat on standardized tests and some cops have planted evidence.  But most folks, I hope and pray, are doing the right thing.

We are all vulnerable to temptation, greed, ethical erosion, self-righteousness and tortured rationalizations to justify our problematic behaviors.   The ends often don’t justify the means. My point is not to tarnish my own profession, but to present it as a human endeavor.  We physicians are human and need to struggle to do right just like everyone else.  And that’s no lie. 

1 comment:

Anonymous said...

It's white-collar and it's not starched from the laundry.

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