“What They Don’t Know Won’t Hurt Them”

In a nationwide survey of roughly 1,800 physicians, 17% had some level of disagreement with the notion that they should “never tell a patient something that is not true.” Not only that, but 11% of those surveyed acknowledged that they had told a patient “something that was not true” in the past year. Huh? What happened to patient autonomy? How can we, the patients, give informed consent if we don’t know the truth about our condition. We can handle the truth! Our relationships with our doctors rely on the principles of autonomy, non-malfeance, beneficence, justice and fidelity at all times. Non-disclosure of medical conditions breaks the trust between the patient and doctor that is so necessary for good patient care.

And, to make matters worse, 34% of those physicians surveyed did not completely agree that “all significant medical errors” should be disclosed to patients, with 20% saying they had withheld information about medical mistakes in the past year. What the hell?

This results of this survey help explain why the number of medical mistakes have not changed much in the last 20 years, despite the number of studies which show that a failure to communicate is the root cause of medical errors. Besides being illegal and morally reprehensible, non-disclosure of medical errors it destroys the doctor-patient relationship which is crucial for good medical care.

“To err is human” is a well known saying that captures the fallibility of human beings; this doesn’t exclude docs. Everyone makes mistakes. However, if you don’t disclose these mistakes you cannot learn from them, so the same mistakes continue to happen. The reasons why mistakes are not disclosed has do to with the culture of medical institutions. It’s a culture of fear: fear of retaliation, humiliation, medical malpractice law suits and being fired. So, many mistakes get swept under the rug.

If this culture of fear is not replaced by a culture of trust, mistakes will continue (or get worse) as we have seen for the past 20 years. Eventually, it all comes out as the folks in Dallas, Texas observed with the fiasco at Parkland Hospital.

Many surveys have shown that patients who have been told of medical mistakes only want to be assured that steps have been taken prevent them from ever happening again. This along with an apology often prevents a malpractice law suit.

We need more communication, not less. When will the leaders of the medical community realize this?

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