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Honesty is the Best Policy in Life and with Your Doctor

By Martha Michael

Woman Sitting Having a Conversation

When it comes to wellness, a lack of honest dialogue with your doctor can minimize progress. As a patient, you want to avoid weaving the tangled web that comes from withholding information from your healthcare practitioner. But in reverse, patients can’t always handle the truth, some experts say.

Medical Community Candor

Do doctors model frankness when it comes to their patients?

Sometimes they should take their lead from Jack Nicholson, says ethics lecturer Daniel K. Sokol in an article in the BMJ, formerly the British Medical Journal. He argues that honesty, for doctors is not always the best policy, particularly in situations with a likely negative outcome. There are times when it’s morally acceptable to tell half-truths or withhold information from a patient, he says, because they can’t handle the truth. So Sokol developed a “deception flowchart” to guide a practitioner who has to deliver bad news. It includes permission to choose euphemisms, ambiguities, evasions and other strategies when necessary. It’s not as unusual as it sounds; in some countries, doctors commonly withhold an adverse diagnosis and prognosis from patients, the article points out.

But if your medical practitioner isn’t completely honest with you, doesn’t it erode doctor-patient trust?

Yes, it can, but Sokol contends that the “ethical duty to be honest is not absolute.” Though couching a prognosis should be reserved for the most extreme circumstances -- when it serves the overall health of the patient by reducing emotional suffering or long-term autonomy. When there’s a terminal diagnosis or it serves to boost a patient’s morale, it may be worth it.

Sokol has two tests for a practitioner when deciding whether a situation calls for a conversation that’s less than entirely truthful. First, doctors should consider if they could defend their choice to mask the truth in front of a professional association. Secondly, they should ask, “If the patient knew all of the facts, would he or she consent to the deception?”

The Patient as Pinocchio

Most Americans would say that you contribute to your wellness by dropping your guard with your medical practitioner, and the U.S. Department of Health and Human Services agrees.

One of the most beneficial aspects to honest communication between doctor and patient is to inform on the decisions they have to make together.

“It’s important to be honest and upfront about your symptoms even if you feel embarrassed or shy,” says an article from the agency. “Have an open dialogue with your doctor -- ask questions to make sure you understand your diagnosis, treatment, and recovery.”

“Stretching the truth” can be taken literally if you don’t talk honestly with your chiropractor. Before you even begin treatment you need an accurate assessment, which is hard to come by without full disclosure.

The goal of chiropractic care is to facilitate wellness, which is mainly accomplished through spinal manipulation. It’s important that patients communicate freely and clearly about any pain or symptoms they’re experiencing in order to receive proper treatment for their needs. Your chiropractor can address joint restrictions or subluxations of the spine best with complete and accurate information.

A practitioner is out on a limb without a patient’s honest history. The best scenario is good communication in both directions.

The DHH offers patients some suggestions to maximize their treatment:

  • Bring to your appointment a list of questions and concerns
  • Have a family member or friend go with you
  • Take notes detailing advice from your doctor about your treatment
  • Keep track of your test results, medications and diagnoses by accessing your medical records
  • Ask your practitioner for his/her preferred method of communication

Twenty-first century research is addressing the need for more honesty by patients, according to an article in The Washington Post by Suzanne Allard Levingston. Scientists at the University of Southern California are applying research showing the benefit of anonymity and rapport when it comes to fostering truthfulness. Levingston, who calls honesty with medical professionals a “bedrock of proper care,” says that patients tend to fib about issues that may stigmatize them, such as drug and alcohol abuse, mental health problems and sexual experience.

Medical professionals can engender more honesty from patients if they explain the need for personal questioning, says Dr. Leah Wolfe, who trains students and faculty at the Johns Hopkins School of Medicine in Baltimore. She believes the information from patients is crucial to good medicine.

“I’m a firm believer that 95 percent of diagnosis is history,” she says.

Prescribing accurately is one of the complications of improper disclosure by patients, says William Tierney, president of the Regenstrief Institute, associated with the Indiana University School of Medicine. As an internist, individuals would lie about taking medications, sometimes embarrassed that they couldn’t afford them. Others would lobby for more drugs because they were illegally sharing or selling them. It can be dangerous either way.

An accurate diagnosis and treatment plan depends on honest reporting by patients. There’s no benefit to holding back when meeting with your healthcare professional, especially if your appearances are deceiving. You may save face in the presence of the doctor, but you’re lying to yourself.

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