Should Doctors Tell the Truth?

Ask most of us if we are honest and we will likely respond in the affirmative.  Who among us wants to admit publicly that we are a cheat or a liar?

It would be more accurate to describe ourselves as mostly honest, since there are occasions when we do some fact massaging and truth shading.  And, sometimes, applying a little spin may be the better choice.

Consider this hypothetical.

Your mom has been working all afternoon to prepare meatloaf as a birthday treat for you.  While it appears appetizing with its golden-brown appearance, it is simply not palatable.  Your mom asks you directly how it is.   Choose among the following potential responses.

• Mom, did you mix in some dog food in by mistake?
• Hey, are you trying to poison me?
• I like the ground glass.  It give the meat a great crunch.
• Mom, this is great!  I hope there will be leftovers for tomorrow, if I can wait that long!

'Mom, the meatloaf was....indescribable!'

While I do believe in the existence of absolute truth, I do not advocate practicing it without exception.  Physicians are charged with honest behavior, but there are circumstances that may demand a more calibrated response.

Here are some hypotheticals where a physician might opt to pull back from sharing the complete truth.

• A patient is scheduled for upcoming surgery.  You are not certain the surgery is necessary.  The patient hasn’t asked your opinion, but are you ethically obligated to offer it?
• A patient asks your opinion on his new primary care physician (PCP), who is a major referral source to the doctor's practice.  While the PCP is considered to be satisfactory, more competent PCPs are available.  Your response?
• A family directs a physician not to inform the patient that he has cancer ‘because the news would kill him’.  Does the physician comply? 
• A patient’s son calls his dad’s doctor to share private information regarding his father’s condition.  The son asks that the conversation remain confidential.  When the father sees the physician, he becomes suspicious and asks the doctor directly if his son has contacted him.  Does the doctor respond truthfully?
• A patient asks the doctor if he has ever lied to his mother. 

So, how truthful should doctors be?  Must they impart the unvarnished truth in accordance with the ethics of the medical profession?   Must the whole truth be shared in totality initially?   What does a physician do if his patient wishes to remain ignorant of salient medical facts?  Can loved ones, who know the patient better, control the flow of information?  Do we expect doctors to comment on the quality of patients’ other physicians or treatment plans?