To Tell the Truth

Thesis: Being truthful with our patients is a necessary part of being a physician.

As physicians, we have a “duty to inform” our patients of their conditions, outlook and possible cure. This may be an implicit requirement or an explicit legal requirement depending on the laws in the state in which we practice. As physicians we are legally expected to tell the truth as we understand it and allow patients adequate information in order to make intelligent choices about their care. More importantly and beyond any legal mandate, telling patients the truth simply demonstrates respect for them and in doing so we create a covenant of trust with them that is central to the practice of medicine. Should individual patients prefer to receive less information about their health scenario or choose to assign their autonomy to others, we can always modify the amount of information we convey to them but never the quality.

When our patients are not told the truth, they are, by definition, uninformed and may not seek care. They may very well fail to receive necessary attention because they are unaware of a problem and will have no incentive to correct it. As well, they might make decisions in their lives that would be very different had they a clearer understanding of their overall health picture. Also, many patients are comforted in having a name assigned to their condition, and not knowing all pertinent information in their case may add anxiety and tension to their decision-making due to a sense of uncertainty. Indeed, persons who are not made aware of health problems are not afforded the opportunity for personal growth as they make choices about how they will receive their medical information and allow it to impact their families. And, without stretching our definition, withholding information from patients could be construed as a deception which would undermine their trust in us and in the medical profession, in general.

So, telling the truth is simply a high ethical standard we maintain as physicians - but we and our patients realize other valuable benefits as well. As stated above, our goal as physicians is to engender the covenant of trust we establish with our patients as central to the practice of medicine. It is plainly the most respectful and legally proper, and financially responsible mode of behavior. Additionally, however, we know from our PCM course material that telling the truth has been shown to cause patients to follow their care plans more closely, decrease patient pain when they have a fuller understanding of their health status, and improve health outcomes as patients are more fully informed. Telling patients the truth also has been shown to increase patient satisfaction in that they feel trusted and a partner in their own health care and makes patients less likely to change physicians when we allow them to participate in decisions about their care. As the final trump, telling the truth has even been shown to decrease malpractice claims.

Truth-telling should plainly be a habit any future physician practices without hesitation. It may require some effort as we consider specific legal requirements and individual cases, but we should always be attempting to tell the truth well as we are able and at every patient encounter. If we are not able to do that, it’s time to pursue another line of work.