Doctors admit they lie to patients and hide mistakes, survey reveals

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By Deborah Kotz, Globe Staff

Most physicians paint overly optimistic prognoses for their patients, and many have told lies or withheld information concerning their medical mistakes and financial relationships with drug companies and device manufacturers, according to a national survey conducted by Massachusetts General Hospital researchers.

The 2009 survey of nearly 1,900 doctors, published today in the journal Health Affairs, shows that many doctors don’t adhere to the standards of medical societies and accreditation groups, which have long required doctors to be open and honest with their patients.

“There’s an expectation that our doctors will be truthful, and most are but some are not,” said study co-author Eric Campbell, director of research at the hospital’s Mongan Institute for Health Policy. The researchers didn’t determine whether any patients were harmed because of a physician’s dishonesty.

The survey found that nearly one-fifth of doctors said they hadn’t fully disclosed their mistakes over the past year in order to avoid a lawsuit.

“I was disappointed to see so many doctors not disclosing errors,” said Arthur Caplan, a bioethicist at the University of Pennsylvania who wasn’t involved in the study. “They may dodge a bullet, but if it’s found out later, they can really get clobbered for not telling the truth — to say nothing of the patient consequences.”

In addition, nearly 40 percent of physicians said they didn’t think it was necessary to tell patients if they had accepted speaking fees or a free vacation from the manufacturer of the drug they were prescribing or whether they owned the scanner for the imaging test they were ordering.

“If a reasonable person might think a financial relationship might affect what drug, procedure, or test they were prescribed, it’s better to disclose,” said Caplan. “A lot of time patients will say they don’t care about the conflict,” but they should be given the chance to ask further questions.

Efforts are underway to make potential financial conflicts more transparent: Partners HealthCare, the parent company of Brigham and Women’s Hospital and Mass. General, may soon start requiring doctors to disclose to patients any substantial monetary ties they have to medical companies. And a new federal law requires pharmaceutical and medical device companies to publicly report any physician payments or gifts worth more than $10. Everything from stock options, meals, and consulting fees will pop up on a searchable physician database slated to appear online in September of next year.

For now, patients facing a choice between multiple procedures or medications might want to ask doctors about any financial interests that could bias them in favor of one treatment over another, said Dr. Michael Barry, president of the Foundation for Informed Medical Decision Making, a Boston-based patient advocacy group.

Barry added that he was “gratified” to see that nearly 90 percent of doctors reported that patients should be fully informed about the benefits and risks of a procedure or drug. He did, though, wonder whether they actually practiced what they preached. “It contrasts with what we found from patients who tell us their doctors tend to present more benefits than risks when it comes to treatments,” he said.

While the survey was anonymous, doctors may have veered a bit toward reporting behaviors that they deemed to be acceptable to their colleagues rather than what they truthfully did in practice, said Campbell. “Only 11 percent of physicians reported saying something untrue to patients over the past year,” he said, “which I suspect is much higher.” The doctors were not asked what they lied about.

Some of the communication lapses reported in the survey may simply be signs that doctors are human. Nearly 45 percent of doctors said they’ve given patients prognoses that are rosier than reality in the past year, which Caplan said reveals their compassionate side. “It’s a human impulse to fine tune how you present bad news or a grim prognosis,” he said. “It’s important to get to the truth, but it’s a process to tell someone they will be dead in six months.”

That’s something doctors are loathe to do, especially when they have a strong relationship with a patient. A study published this week in the Annals of Internal Medicine found that most patients with incurable lung or colon cancer don’t discuss their end-of-life care options with their doctors until a few weeks before they die. More than three-quarters had these discussions with physicians they didn’t know during an emergency hospital visit, rather than with their regular oncologist.

“I understand why this happens. I have this instinct, too, to not want to cause harm and pain to people by bringing up topics” such as death and how it should be managed, said study author Dr. Jennifer Mack, a pediatric oncologist at Dana-Farber Cancer Institute. “But I also feel obligated to do it.” And patients may be grateful for doctors who convey that last bit of hope.

While medical association guidelines recommend that doctors discuss end of life care with all cancer patients who have a life expectancy of less than one year, the timing of those discussions are left to the doctor and patient. “We’re still learning about the right time to have these conversations,” said Mack. “What’s right for one family may not be right for another, and I ask what’s important for you to know right now? Would it be helpful to talk about your prognosis?”