Many physicians report not always being completely honest with their patients and more than 10% say they’ve told a patient something untrue in the past year, despite professional charters and standards that call for openness and honesty in all communications with patients, according to a study published in Health Affairs.
In addition, one-fifth of physicians said they did not fully disclose medical mistakes to patients because of fears of lawsuits.
"Despite widespread acceptance of communication principles and commitments by professional organizations, substantial percentages of U.S. physicians did not completely endorse these precepts, and many reported behaving in ways that deviated from these norms," wrote Dr. Lisa I. Iezzoni, director of the Mongan Institute for Health Policy at Massachusetts General Hospital, Boston, and her colleagues.
The study authors surveyed 1,891 practicing physicians, asking them questions about attitudes and behavior related to physician-patient communication. Because respondents probably tended to answer questions in a way that others would view favorably, the authors said the survey may underestimate communication failures between doctors and patients.
Most respondents agreed that physicians should fully inform patients about the risks and benefits of interventions (89% agreed), never tell a patient something that is not true (83% agreed), and never disclose confidential information to unauthorized persons (91% agreed), according to the survey (Health Affairs 2012;31[doi:10.1377/hlthaff.2010.1137]).
However, the study found that approximately one-third of physicians did not completely agree with the need to disclose serious medical errors to patients, about 17% did not completely agree that physicians should never tell a patient something untrue, and more than 35% did not completely agree that they should disclose their financial relationships with drug and device companies to patients, the study reported.
When asked about their own behavior in the past year, more than 10% said they had told an adult patient or child’s guardian something that was not true, and almost one-fifth said they had not fully disclosed mistakes to patients for fear of being sued, the study said. In addition, more than one-quarter reported revealing unauthorized health information about a patient, and more than half said they had described a prognosis more positively than the facts warranted, the study found.
Women physicians were more likely than men were to provide responses consistent with professional charter principles on four questions: those concerning never telling patients something untrue, fully describing benefits and risks, disclosing financial relationships, and never having told an untruth in the prior year, the study found.
Physicians from underrepresented minority groups – that is, minority groups other than Asian – were more likely than were white or Asian respondents to report attitudes consistent with professional charter commitments, the investigators found. In addition, physicians who had graduated from medical schools outside the United States were more likely to say they never tell untruths and never disclose confidential patient information.
General surgeons and pediatricians were most likely to completely agree about needing to disclose all serious medical errors to patients, while cardiologists and psychiatrists were least likely to report this attitude. However, the questions involving self-reported actual behavior in disclosing errors found no significant differences by specialty, the study said.
Anesthesiologists, general surgeons and pediatricians were most likely to report never having described patients’ prognoses in more positive terms than warranted, while internists and psychiatrists were least likely to report this, the study said. Cardiologists and general surgeons were most likely to report never having told patients an untruth in the previous year, while pediatricians and psychiatrists were least likely to report never having told untruths, according to the study.
The results suggest that many physicians do not completely support physician charter requirements dealing with doctor-patient communications, the authors wrote. However, "an alternative interpretation is that treating support for the charter precepts as ‘black or white’ – physicians either do or do not completely endorse and adhere to these principles – fails to recognize complexities of patient-physician communication in everyday practice," they said.
External financial support for the survey was provided by the Center on Medicine as a Profession at Columbia University, New York.