“There’s a 99 percent chance this is nothing,” said my internist encouragingly, referring me to a cancer specialist after I’d had repeated abnormal blood counts.
The oncologist I saw next reviewed my unusual symptoms, promptly asked about a tiny lump on my neck and mentioned Hodgkin’s disease. The diagnosis was confirmed the next day with a biopsy.
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That was years ago and my treatment was successful. But did my primary care doc really send me to a cancer specialist thinking it was nothing serious? A study in Health Affairs found that more than 55 percent of 1,891 physicians surveyed admitted they often or sometimes presented a rosier prognosis than the facts supported.
“I’ve had doctors minimize things almost every time I see them,” said Trish Rose Malloy, a graphic designer in Bucks County, Pa., whose abdominal cramping and back pain turned out to be ovarian cancer. “It’s my primary care doctor’s MO to keep me calm and not alarmed ‘until we know more.’”
Not wanting to worry a patient is one reason for “bright siding,” a term popularized by the late Barbara Ehrenreich that means unsubstantiated reassurance or sugarcoating of the truth. Other times, it’s to avoid offending a patient or creating conflict, such as not suggesting to a parent that a child needs to lose weight. Or doctors may not have the heart to acknowledge themselves when a patient is declining, so you don’t get the message.
A dodge by a physician can feel invalidating and frustrating when a patient or a caregiver suspects all is not well. Ellen Lutwak, a copywriter in West Los Angeles, questioned a doctor when her mother, in her late 80s, began ranting in “anger off the charts.” The doctor, focused on her mother’s heart disease, shrugged off Lutwak’s concerns. Her mother’s dementia was confirmed later at a Southern California hospital when she was admitted for cardiac care.
Lutwak believes her mother’s primary doctor recognized the dementia but didn’t want to address it, perhaps out of concern about her mother’s potentially angry reaction. Research in 2021 from Alzheimer’s Disease International found that stigma and lack of awareness of dementia among doctors remain major barriers to diagnosis around the world.
You can’t handle the truth
Since then, the doctor-patient partnership model has replaced that sort of medical paternalism. Yet doctors still make routine judgments about how much to tell patients.
Too much information can be unhelpful and confusing, said Eric Campbell, professor of medicine at the University of Colorado and director of research at the UC Center for Bioethics and Humanities. But should a doctor decide that medical choices are over a patient’s head so they shouldn’t be mentioned or that a patient is too fragile to handle difficult news?
Experts say such assumptions can reflect an implicit bias that can lead to health disparities. Poorer outcomes can result when a doctor’s unconscious feelings about skin color, gender, disability, age or ethnicity influence what gets shared.
In my case, I think that my being 28 at the time was a primary reason my doctor didn’t raise the possibility of cancer — either due to the unlikelihood at my age or not wanting to deliver bad news to someone so young.
Clinicians may also soften language, trying to be kind or not scare a patient, said Lea Brandt, director of the University of Missouri Center for Health Ethics. They may say “a growth” vs. “tumor,” “overweight” vs. “obese.”
“Using euphemisms is problematic if the patient walks away not realizing how serious the condition is,” she said. Someone who is not informed they will probably die within months, for example, is robbed of time to tackle their bucket list.
There is a sweet spot between protecting the patient from emotional distress and being open, said Ronald Epstein, professor of family medicine, oncology and medicine (palliative care) at the University of Rochester School of Medicine and Dentistry. Doctors aren’t trying to deceive patients — but empathy may get in the way of being more direct. Sometimes physicians delay disclosing a bad diagnosis until they think a patient is ready to understand and emotionally absorb the news, he said.
When Malloy was diagnosed with late-stage ovarian cancer in 2018, she was confused by her oncologist’s positivity.
Malloy pointed out the dismal survival statistics she had seen, while her oncologist responded he had patients living five years and longer after treatment. He told her that the information she had found on the internet was dated. But “he was careful not to give any concrete statements about survivorship,” Malloy said.
Malloy, who took part in a National Institutes of Health-sponsored clinical trial through her doctor, said she felt he had minimized her concerns about potential unknown side effects of the trial drug. Instead, he emphasized that he would be closely monitoring her and that her participation would benefit other women.
Physicians may frame a recommendation in positive terms to persuade patients to take their advice, Brandt said. This includes understating risks or exaggerating benefits if they think the helpfulness of a treatment outweighs the negatives.
Today, Malloy is in remission. She has not been told yet whether she received the drug or the placebo in the ongoing trial, but she strongly suspects she is alive because she got the drug. Despite her feelings that he had minimized the risks of the clinical trial, she credits her doctor — and the medicine she got in the trial — with saving her life.
Do we have to talk about that?
Years before her own cancer bout, Malloy watched her mother’s doctor skirt the subject of dying during her mother’s treatment for breast cancer.
“My mom was clearly ready for hospice, yet my family could not get [her physician] to actually suggest it,” she said. “We were waiting for guidance — for him to tell us ‘it’s time’ — and he was waiting for us to inquire about it.”
Finally, after six years of treatment, Malloy’s family brought up hospice; her mother died at home a few weeks later at age 69. Had the doctor been forthcoming about how close to death their mother was, the family would have wanted her in hospice care much sooner, Malloy said
“It’s a conspiracy of silence,” said Epstein, who noted the situation that Malloy’s family found themselves in is not unusual.
As a health-care communications researcher, he frequently reads transcripts with vague or evasive language surrounding death — the ‘D’ word, as he puts it. Examples he has encountered include “We’ll just see what the next scan shows,” or “We’ll consider chemo again once you regain your strength” (while knowing the patient won’t).
The reluctance of a doctor to admit uncertainty or lack of knowledge is another form of nondisclosure.
Tests often don’t reveal what’s causing back pain or fatigue, for instance, but patients may pressure a doctor for a diagnosis. Rather than saying “I don’t know,” doctors often attribute a patient’s symptoms to stress, Epstein said.
Doctors also may fail to broach subjects due to their own discomfort, Campbell said. “A classic example is obesity,” he said, noting a study that showed doctors who were overweight themselves were less likely to bring it up.
If a doctor fails to ask about a sensitive matter, Epstein said patients must do it themselves. For example: “I have a personal problem with sexual function. Is that something I can ask you about?”
Sometimes, getting the short-shrift on information is simply due to a time crunch. A doctor who is running late may skip over the side effects of a procedure if they see it as standard care. Or a burned-out physician may not be in the state of mind to ask if you have questions at the end of an office visit. Or a doctor may also be in denial about a patient’s decline so families don’t get that information.
Feel like you’re being soft-balled, falsely reassured, minimized, not told enough or pushed in one direction? “Some physicians have received no training in communication skills,” Epstein said.
If you don’t want your doctor to hold back, say so, he said. “Let the doctor know that even if it’s bad news, you want to hear it.” Usually, you’ll get a franker response — but it’s your choice to seek another physician if the doctor continues to be vague, Epstein said.
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FAQs
A provider can lie to a patient about the nature of a diagnosis or the risky nature of a procedure. Or, rather than lie, the provider can leave out important details and allow the patient to come to a false belief about a diagnosis or level of risk.
Can doctors withhold information from patients? ›
Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient's knowledge or consent is ethically unacceptable.
How do doctors figure out what's wrong with you? ›
A diagnosis is typically obtained by a doctor or other healthcare provider and usually begins with a physical examination and an exploration of the patient's history. From there, tests and other diagnostic procedures are recommended in order to determine the underlying illness or injury that is causing the symptoms.
What is truth telling in medical ethics? ›
Truth telling in medical ethics involves the moral duty to be honest with patients about conditions, medications, procedures, and risks, and this can often be unpleasant, but it is generally necessary. As recently as the 1960s, most physicians believed that patients would rather be lied to than told a horrible truth.
What is an example of benevolent deception? ›
As children, we are taught benevolent deception: to say we like the food that's put in front of us, to pretend we're happy to receive socks for our birthday, and to suppress our potentially hurtful observations about strangers.
What is it called when a doctor lies to you? ›
The law considers it medical negligence if a doctor fails to provide the truth for informed consent, which may also bring a battery lawsuit. If you believe your doctor lied to you, which resulted in injury or harm, contact a personal injury attorney with specific background in medical malpractice.
What are the five right of a patient? ›
Most health care professionals, especially nurses, know the “five rights” of medication use: the right patient, the right drug, the right time, the right dose, and the right route—all of which are generally regarded as a standard for safe medication practices.
Do doctors tell you how long you have to live? ›
Surveys consistently show that the majority of people with advanced illness want to know how long they have to live. However, only 43% of oncologists report usually having conversations about life expectancy with patients.
What does it mean to withhold information deliberately? ›
Concealment is the act of intentionally or unintentionally not revealing information that should be disclosed and would otherwise affect the terms or creation of a contract. A concealment can occur through either purposeful misrepresentation or withholding of material facts.
What are the signs of medical Gaslighting? ›
What Are the Signs of Medical Gaslighting?
- Dismiss the patient's symptoms and fail to take their concerns seriously8.
- Don't listen to the patient or constantly interrupt them8.
- Laugh at their patients' concerns or suggest that what they're experiencing is in their head8.
Arrogance is often just a cover for vulnerability, and with so much information that we're expected to digest, we are at risk for making a bad decision if we aren't up to date.” Another reason why doctors can come off as condescending is because they sometimes feel that they are henpecked. Dr.
How do you tell a good doctor from a bad doctor? ›
What makes a good doctor? Here are 7 signs you have a great one
- Sign #1: They listen to you. ...
- Sign #2: They ask you questions. ...
- Sign #3: They show concern for your feelings. ...
- Sign #4: They explain things in a way that makes sense to you. ...
- Sign #5: They include you in making decisions.
Be amused, bemused, or irate privately, not in front of the patient. It may only encourage him or her to lie again. Try to remain emotionally neutral when you explain to the patient that you can't do your best without full cooperation. People who tell lies tend to do so habitually.
How do you know if a patient is telling the truth? ›
However, experts say the following techniques can help physicians ferret out patients' fiction. According to the WSJ, many doctors look for signs of lying, such as avoiding eye contact, frequent pauses in the converstion, unusual voice inflections and other signs of anxiety.
What is nonmaleficence? ›
Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect.
What are the 3 different types of deception? ›
Buller and Burgoon (1996) have proposed three taxonomies to distinguish motivations for deception based on their Interpersonal Deception Theory:
- Instrumental: to avoid punishment or to protect resources.
- Relational: to maintain relationships or bonds.
- Identity: to preserve "face" or the self-image.
Lying is a common form of deception—stating something known to be untrue with the intent to deceive.
What are the three levels of deception? ›
A valuable skill is recognizing the three types of deceptions: strategic, operational, and tactical.
What is doctor Gaslighting? ›
“Medical gaslighting is the experience of patients feeling like their complaints are dismissed, discounted, or discredited,” says Kim Gorgens, PhD, Clinical Professor and Director of Continuing Education at the Graduate School of Professional Psychology at the University of Denver.
What is a dismissive doctor? ›
Here are a few situations that may cause a doctor to be dismissive of a patient: The doctor believes the patient is lying in order to gain something or feed an addiction. For example, a patient who complains about severe pain just to get a prescription refilled. The doctor is simply having an off day.
If the doctor is condescending or makes you feel foolish, it's not a healthy partnership. Likewise, with a chronic disease, your doctor should encourage you and your family members to be active participants in managing your health. Remember your doctor is working for you.
What patient right is most often violated? ›
What Patient Rights Are Most Often Violated?
- Understaffing (considered a primary cause of patient rights violations).
- Failure to provide quality care and proper nursing services.
- Failure to adequately educate patients and help them make informed decisions about their treatment plans.
To have the physician and other staff respect the patient's privacy and confidentiality. To obtain copies or summaries of their medical records. To obtain a second opinion. To be advised of any conflicts of interest their physician may have in respect to their care.
What are the 8 patient rights? ›
What are the 8 rights of medication? The eight rights of medication are right patient, right medication, right dose, right route, right time, right documentation, right reason, and right response.
What do doctors say when a patient dies? ›
Use “died” or “dead” during the initial conversation. Listen for the words used by the family/significant others to describe death and use their term(s) throughout the remaining discussion. Refer to the deceased by name. If requested, explain the cause of death in non-medical terms.
How do doctors decide to turn off life support? ›
If there's an agreement that continuing treatment is not in your best interests, treatment can be withdrawn, allowing you to die peacefully. The palliative care team will make sure you're comfortable and do not feel pain or distress.
What oncologists won t tell you? ›
In some cases, oncologists fail to tell patients how long they have to live. In others, patients are clearly told their prognosis, but are too overwhelmed to absorb the information.
Is withholding info lying? ›
Lying is only one of many forms of deception, which occurs anytime you knowingly allow someone to believe something that is not true. And, yes…lies of omission (intentionally withholding information) are deception, too.
What is it called when you withhold the truth? ›
Definitions of prevarication. the deliberate act of deviating from the truth. synonyms: fabrication, lying. types: fibbing, paltering.
What is it called when you lie by withholding information? ›
Sometimes people may choose not to reveal certain information, which is called a lie of omission. A lie of omission is when someone intentionally withholds relevant information, leading the other person to believe something untrue.
Ghosting is a visual artifact that occurs in magnetic resonance imaging(MRI) scans. These artifact are a consequence of environmental factors or the human body (such as blood flow, implants etc.).
When a doctor dismisses your concerns? ›
Having one's symptoms dismissed by a health care professional is sometimes called “medical gaslighting,” a term that comes from Gas Light, a 1938 play that was later adapted into a movie, in which the husband manipulates his wife into questioning her perceptions of reality and her sanity.
What is an example of medical gaslighting? ›
For example, telling a patient they're not sick, because the doctor is lazy to perform tests or is biased–gender or racial biases. Women and people of color are more commonly the targets of medical gaslighting. This is according to a 2021 research by the College of Family Physicians of Canada.
What is unethical behavior for a doctor? ›
Working while impaired by alcohol or drugs. Becoming romantically involved with patients or family members of a patient. Cherry-picking patients. Breaching patient confidentiality (violating HIPAA regulations)
Do doctors gossip about their patients? ›
Specifically, it uses the phrase “professional judgment” often. In other words, the doctor may talk about their patients to others when they believe the discussion they're having is in the best interest of their client.
How to deal with a narcissistic doctor? ›
Avoid being defensive, but be ready to calmly counter these unfair attacks when they are brought to your attention. Stay focused on the main issues when you make a complaint, and always use facts and evidence, not hearsay or rumor.
What not to say to a doctor? ›
Anything condescending, loud, hostile, or sarcastic
Although most people realize that doctors are regular people, too, some believe that doctors are never allowed to make mistakes. Patients need to realize that doctors are their partners, and getting belligerent or nasty will only harm the relationship.
How do you respond to a rude doctor? ›
Say something about it, and be very firm. "I do not appreciate your making comments under your breath about my weight. That's very rude." If possible, say it within earshot of others so that the story won't be told later by the insultor, making you out to be the person who was out of line.
When your doctor is dismissive? ›
If the doctor is being dismissive, push back. Engage them as you would a partner. Let them know you appreciate their expertise, but remind them that you are the foremost expert on your own body. Work together to reach a diagnosis and treatment plan.
How honest are people with their doctors? ›
On the upside, most people (77% of those surveyed) are honest with their doctors. Why do patients lie? Some 75% of respondents cited embarrassment as the reason.
Physicians also lie to respond to intense competitive pressures. Lying may help a physician avoid interpersonal or intrapsychic conflicts or difficult topics (eg, talking openly about disability or death). Prevarication may also represent an effort to encourage a particular treatment agenda.
Are patients honest with their doctors? ›
A recent survey of Americans insured under Medicare Advantage plans found that 47% lied to their doctors, mostly about their diets, exercise habits, sex lives or adherence to treatments. Patients lied mainly out of embarrassment and were more likely to lie to younger, male doctors.
Should doctors tell patients the truth? ›
When physicians communicate with patients, being honest is an important way to foster trust and show respect for the patient. Patients place a great deal of trust in their physician, and may feel that trust is misplaced if they discover or perceive lack of honesty and candor by the physician.
How do you tell if a patient is lying about pain? ›
“They get angry or irritable because they start to anticipate you will refuse them. That can be a tip-off.” If the patient says he has taken more of the pain medication than ordered or used it for other purposes or in a different form, these are signs of misuse, Williamson added.
Can deceiving patients be morally acceptable? ›
Although deception in medicine is generally wrong, as it tends to undermine patients' autonomy and erode the trust between doctor and patient, the ethical duty to be honest is not absolute.
What is Beauchamp and Childress? ›
Thomas L Beauchamp (1939—present) and James F Childress (1940—present) are American philosophers, best known for their work in medical ethics. Their book Principles of Biomedical Ethics was first published in 1985, where it quickly became a must read for medical students, researchers, and academics.
What are the four medical ethics? ›
The four principles of Beauchamp and Childress - autonomy, non-maleficence, beneficence and justice - have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care.
What is a moral distress? ›
'Moral distress is defined by the author as the psychological disequilibrium & negative feeling state experienced when a person makes a moral decision but does not follow through by performing the moral behavior indicated by that decision' Psychological effects.
Is it justifiable for the doctor to deceive his her patient? ›
Although deception in medicine is generally wrong, as it tends to undermine patients' autonomy and erode the trust between doctor and patient, the ethical duty to be honest is not absolute.
Is it the physician's duty to disclose the truth to her patient? ›
To avoid legal action, according to the doctrine of informed consent, physicians must disclose enough information for the patient to make an “informed” decision.
Physicians should not decline patients for whom they have accepted a contractual obligation to provide care. However, physicians are not ethically required to accept all prospective patients. Physicians should be thoughtful in exercising their right to choose whom to serve.
Do doctors have an ethical obligation to admit error? ›
The American Medical Association's Code of Medical Ethics (the Code) requires doctors to inform patients of medical error.
Can you morally obligated the doctor to do something against his belief? ›
“Neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles.
Should a patient be told he is dying? ›
When someone may be entering the last days of life, a healthcare professional should tell the patient that they're dying (unless they don't want to know).
When can patient autonomy be overruled? ›
A patient's autonomy is violated when family members or members of a healthcare team pressure a patient or when they act on the patient's behalf without the patient's permission (in a non-emergency situation).
Are physicians morally obligated to regard every patient request as legitimate? ›
Physicians are obliged to regard every patient request as legitimate. According to Roman Catholic doctrine, a hopelessly ill patient has the right to refuse extraordinary life-sustaining treatments.
What is a violation of ethics in doctors? ›
Some examples of violations of medical ethics include: A doctor or psychiatrist who has sexual contact with a patient. Failing to give a patient information that would allow them to make informed decisions about care. Disclosing a patient's confidential information without their consent.
What is it called when a doctor makes a mistake? ›
When a doctor makes an unavoidable mistake that another doctor would have made in the same circ*mstances, it's just a mistake. However, if they made a mistake as a result of negligence, it's called medical malpractice.
What are the 2 ethical concepts that are violated when an error is not reported? ›
Additionally, the ethical principles of beneficence (doing good) and nonmaleficence (preventing harm) are violated when errors are not reported or disclosed.
