The recent hubbub about ex-University of Arkansas football coach Bobby Petrino, which centered on the latest examples of his propensity for lying to his superiors, got me to thinking.
Not so much about how proven prevaricator Petrino finally lied his way into the ranks of the unemployed, although I did enjoy reading statements such as this classic from SI.com writer Michael Rosenberg: “The . . . university is shocked to discover that its lying-weasel football coach is a lying weasel.”
Rather, the extensive coverage of the circumstances of Petrino’s self-inflicted fall from grace led me to revisit a question that touches on truth-telling in the medical arena. It got me thinking about the reports I had seen a few weeks back on studies indicating that a considerable number of physicians regularly lie to their patients, apparently with few qualms about doing so.
Clearly the misadventures of Petrino serve as quite the metaphor for the inadvisability of being less than truthful. In the coach’s case, that left him with a well-documented reputation as someone not to be trusted, even though he had led the Arkansas program to considerable recent success.
So I went back and dug out some of the reports on the docs-lying-to-patients study originally reported on back in February. That study of U.S. physicians indicated that many among them lie to their patients and/or withhold information about medical mistakes, while also failing to disclose their financial relationships with medical companies.
The findings were reported in the February issue of the journal Health Affairs, and Dr. Lisa Iezzoni, professor of medicine at Harvard Medical School (Boston) and director of the Mongan Institute for Health Policy at Massachusetts General Hospital (Boston), who was the lead author of the article, said the results don’t bode well for healthcare that should be focused first on the needs of patients.
“It really is important for patients to have complete information about their prognoses if they’re going to make informed decisions,” Iezzoni said.
While the thought that there are some physicians who see little wrong with not being truthful with their patients or their caregivers as to the extent of their conditions is unsettling, I’m bothered even more by the cavalier attitude so many seem to have toward disclosure of financial relationships with drug and device companies. That type of thinking is downright disturbing, and should raise some interesting conflicts with new, highly specific disclosure laws due to take effect next year in the form of the Physician Payment Sunshine Act. For those docs who don’t get it, that’s “Sunshine,” as in shining light upon.
Another national survey released about the same time as the Mass General study found that nearly all orthopedic surgeons admitted practicing “defensive” medicine – the ordering of unnecessary tests, procedures and referrals – to avoid future liability. In the study, that was presented during the February annual meeting of the American Academy of Orthopaedic Surgeons (Rosemont, Illinois), some 96% of the more than 1,200 orthopedic surgeons who responded admitted ordering tests, procedures or hospital admissions primarily to avoid possible malpractice lawsuits.
The study shows that physicians “are clearly concerned about malpractice issues and they’re adjusting their practice procedures based on that fear,” said study lead author Manish Sethi, MD, co-director of the Vanderbilt Orthopaedic Institute Center for Health Policy (Nashville, Tennessee). Douglas Lundy, MD, chairman of the AAOS Medical Liability Committee, added that defensive medicine not only drives up the cost of patient care, but also “limits patient access to specialty care, neither of which is in the interest of our patients.”
So on the one hand we have physicians being less than truthful with their patients and on the other those in some specialty areas who simply opt not to provide care to higher-risk patients.
What’s a body to do? Well, I truly don’t have an answer for the “sorry, no care” crowd, but as for the lying weasels – oops, that was for Coach Petrino – my suggestion as a patient advocate, which is based on my own experience as a patient, is to emphasize to the docs with whom you have ongoing relationships that you’re interested in hearing the truth.
That should especially apply to your medical condition, but let him or her know that it also means you don’t want to be prescribed a drug or a procedure whose basis for use is the physician’s relationship with a company.
I liked a comment I read on this subject, uttered by Eric Campbell, PhD, research director at the aforementioned Mongen Institute and another co-author of the study: “I think patients need to be empowered to have very frank discussions with their doctors about the levels of truthfulness they expect from physicians and their healthcare team. It’s not unreasonable to begin a discussion with your doctor and say, ‘Look, I want you to be as honest as you possibly can. If an error occurred on my case, I would like to know about it.’”
(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)