Is your doctor always telling you the truth?

Maybe not, according to a survey on doctor honesty. More than 1,800 doctors nationwide answered anonymously.

"Fifty-five percent said in the last year they described a patient's prognosis in a more positive way than was warranted," says researcher Lisa Iezzoni, MD, director of the Mongan Institute for Health Policy at Massachusetts General Hospital. She is also professor of medicine at Harvard Medical School.

More than a tenth said they had told an adult patient or a child's guardian something that was not true.

"Nearly 20% of doctors had not disclosed mistakes to their patients because they were afraid of being sued," she tells WebMD.

However, the survey did not ask for explanations. In some cases, she says, there could be a plausible reason to bend the truth. A patient with a terminal illness may have told her doctor she does not want to know how bad it is looking, for instance.

The study is published in Health Affairs.

Doctor Honesty: More Survey Results

The researchers wanted to see if the doctors followed the standards spelled out in the Charter on Medical Professionalism. This was published in 2002 by the American Board of Internal Medicine and endorsed by more than 100 medical professional groups. It addresses responsibilities and communication topics, such as honesty in talking to patients so they can make an informed decision.

Doctors surveyed are in pediatrics, family practice, surgery, anesthesiology, psychiatry, internal medicine, and cardiology.

They were given $20 to mail back the survey.

Among the findings, most doctors agreed they should:

• Fully inform patients about the risks and benefits of a treatment
• Not lie to patients
• Not disclose confidential information to unauthorized people

Other findings:

• More than a third did not completely agree they should divulge all financial ties with drug and medical device companies.
• More than a quarter said they had revealed unauthorized health information about a patient.
• Women were more likely than men to say they follow the principles.
• Minority doctors were more likely than white or Asian doctors to say they follow the principles.

Doctor honesty differed by specialty, Iezzoni says. Cardiologists and general surgeons were more likely to report having honest communication with patients, she says.

Doctor Honesty: Possible Interpretations

Iezzoni says she is not discouraged by the results. "I do think it raises a lot of questions about this mantra repeated over and over again in health care reform about patient-centered care," she says.

"You can't have true patient-centered care until patients are fully informed and can become educated and involved in their medical care, to the extent they want to be," she tells WebMD.
Patients need to decide how much they want to know, she says. "My advice to patients is to think deeply about the extent they want to have open conversations. If they do, realize this is something physicians are professionally and ethically obligated to do."

Patients should feel comfortable asking their doctor questions, she says. However, she admits some can get ticklish. One example: asking your doctor if he has ties to the company that makes the drug he has just prescribed. (By March 2013, drug and medical device companies must report payments to doctors in excess of $10. This is required by the Physician Payment Sunshine Act of 2009. The information will be on the Internet.)

"I think these are important findings," says Caleb Alexander, MD, a faculty member at the University of Chicago's MacLean Center for Clinical Medical Ethics. He is also an associate professor of internal medicine. It should motivate doctors and patients to talk about their relationship, he says.

However, he tells WebMD, not knowing the explanation for the behaviors is a limitation.

A doctor bending the truth may be doing so out of his own best interest or the patient's, Alexander says.

For instance, if he has a highly anxious patient who has one lab test that is slightly out of the normal range -- but does not pose a problem to her health -- he may tell her all is well rather than alarm her without need.