Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor
Dept. of Podiatric Medicine
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences
St. Pomona, CA

Liar Liar

I'm feeling a little philosophical this week. We had an issue at home with one of the children that had me thinking about lying and its significance. Without going into detail about my child's personal life – the issue is his own and not for me to broadcast – I can say the situation is nothing out of the ordinary for a young person. In fact, lying is as much a part of life as anything else, likely present since the first humans were able to communicate with each other. But in medicine, lying takes on a different significance.

collaboration Having a medically based relationship with a patient requires a higher level of honesty than most relationships. This is such an important concept that in 2002 the American Board of Internal Medicine, in combination with other international medical leaders, wrote Medical Professionalism in the New Millennium: A Physician Charter.¹ Included in this influential paper, published in more than 300 journals with over 100,000 copies distributed,² is a "commitment to honesty with patients."

This tells the story:

"Physicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy. Physicians should also acknowledge that in health care, medical errors that injure patients do sometimes occur. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patient and societal trust. Reporting and analyzing medical mistakes provide the basis for appropriate prevention and improvement strategies and for appropriate compensation to injured parties".¹

trust This is pretty heady stuff if you ask me. It is essentially a guideline for appropriate physician behavior as it pertains to honesty. And yet, despite these best intentions, doctors are still not as honest as we should be. A survey of 1891 practicing physicians world-wide performed in 2009 found the following troubling statistics:³

1/3rd of physicians did not completely agree with disclosing serious medical errors to patients.
Almost 1/5th did not completely agree that physicians should never tell a patient something untrue.
Nearly 2/5ths did not completely agree that they should disclose their financial relationships with device and drug companies to patients.
A little more than 1/10th said they had told patients something untrue in the previous year.

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I can understand some of the potential for dishonesty. Some physicians may be attempting to protect themselves from litigation, while others may simply be trying to diminish their patients' pain by obfuscating the prognosis of a negative diagnosis. Either way, physicians are human with human strengths and weaknesses.

Are patients any different? I doubt it. I have patients lie to me all the time. I've had several patients tell me they stopped smoking while I can clearly see the cigarette box in their shirt pocket. The same is often true with diabetics and their blood sugars. Ask "how is your blood sugar," and they will invariably answer "good." Ask them what "good" is and they'll answer, "Around 120." Check the sugar in the office and it will often be much higher.

My personal favorite is when one of my diabetic patients comes in to the office wearing sandals. Their answer to my question "why aren't you wearing your prescription shoes" is invariably "I just wear these to see you." I don't believe this one for a minute. If they want to wear something easy to donn and doff then they're likely wearing that same sandal all the time. One just has to recall the study by David Armstrong, DPM and colleagues to know diabetics wear their prescriptive shoes only 15% of the time when at home.⁴ Liar liar shoes on fire!

Are we all doomed to lie to each other? Is that just human nature? Maybe. Maybe not. Personally, I'll stick with 2 trite rules: honesty is the best policy and do unto others as you would have them do unto you. If I want to be treated honestly by my patients, then I'd better do the same with them. It's worked well for me so far. I think I'll stick with it.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]