How Much Should You Tell Your Doctor?
Honesty is a vital component of any relationship.
Imagine a marriage where one or both parties are repeatedly dishonest with each other. Excuses and confabulations are repeatedly made to cover up deficiencies. Problems are glanced over and not identified as important. Commitments are made without any intention of fulfilling them.
How can this marriage thrive or even persist?
ANY relationship suffering in this way seems doomed for failure - and this includes a doctor-patient relationship.
Why then, is dishonesty so commonplace between doctors and patients on both sides of the relationship? This blog will explore the problem of open, honest communication between doctors and their patients.
Why Patients Lie to Their Doctor
Let's talk about patient dishonesty first. To be honest, as a doctor this is the least painful for me and I will procrastinate covering MY faults for a few paragraphs.
Frankly speaking, most patients lie to their doctor.
Men are the worst offenders. Estimates say that 85% of them lie to their doctor routinely.
I hear, "I only missed maybe one day of my medicine," as I hold a report from their pharmacy showing they have not filled their prescription routinely. I hear, "I am smoking a lot less and nearly have this thing licked," and then watch as they light up as they drive away from the office.
I understand that patients want to please their doctors.
In many ways, a physician can be looked at as a parental figure. Unfortunately, because of this, patients avoid exposing their challenges and struggles. Sometimes, it's just plain easier to avoid the truth.
One of my children has coined the term "the REAL truth" when she really wants to be believed. Perhaps patients, like my daughter, see the truth on various levels.
The REAL Truth
The fact is, when it comes to health care, the truth is pretty much black or white. Medicine is either taken or not. Cigarettes are smoked or they are not.
The variable here lies in the struggle.
Perhaps patients think that their doctor will judge them, much like a parent would. The fact is, however, that doctors are human as well! And in truth, the relationship would be better seen as a partnership.
I often tell my patients that they are the captain of their own ships. My job is to sit beside them and advise them about dangerous reefs, icebergs and storms ahead as they navigate the waters. I also encourage them when they do a good job, but in a way that is more like a friend than a parent.
Opening Up So My Patients Can Too
When patients see me as a human with my own struggles, I believe it is easier for them to be honest as well. This is one reason I got rid of my white coat when I finished residency - it posed too much of a barrier. It intimidated patients and really didn't do much more to protect me from germs and bodily fluids than any other clothing would.
As I have gotten to know my patients, it has been easier and more natural to open up. Sharing my own struggles in a way to break down the barriers to open, honest communication. My hope is that my OWN honesty will make my patient rooms less like a court room exposing their faults and passing sentence and more like a sanctuary - a place where patients can feel free from the realities and judgements of the world.
Reminding them that ours is a special relationship with complete confidentiality helps as well.
Honestly (no pun intended), if I allowed myself to feel responsible as a parent would be for each of my patients, I would be torn apart with the responsibility, disappointment and fretting. Sleep would be difficult constantly wondering if my thousands of "kids" are alright.
Don't get me wrong.
I DO have a responsibility and I definitely worry about my patients - but within reasonable limitation. And this also makes it easier to be honest with patients about my own struggles and faults. It's part of what makes those relationships work - giving between both parties.
The Truth That's Hard to Say
Though many doctors do not believe in personal openness, I find it important in my relationship with patients.
And that's not to say it's easy. I am a non-confrontationalist by nature. The "I'm alright, you're alright" mentality is definitely the easy road. Honest communication with patients for me is difficult.
When I see a behavior or tendency that will have potentially devastating consequences for a patient down the line, it is my responsibility to bring it up. But it's beyond that - it's partnering to help make the change.
Let's chose obesity as an example.
A patient's obesity may be the common denominator with their high blood pressure, fatigue, knee pain, diabetes and depression. As I work to help a patient with their problems, it would be a failure on my part to not identify the patient's obesity just because it is an "uncomfortable topic."
If a patient comes in with a breast lump and I fail to identify it as life-threatening breast cancer, this is malpractice. Difficult topics - obesity or smoking - should be no different as potentially life-threatening causes of heart disease or stroke.
The Right and Wrong Way
Believe me, though, there is a right and wrong way to communicate these topics with patients.
The wrong way is the paternalistic route - the one where you use guilt and threats of consequence to shame your patients into the right course.The right way, on the other hand, is both compassionate and honest. Using my own personal struggles and successes is a part of this approach as it helps to encourage the partnership. Discussions about my expectations are also open. I let them know that what I expect of them is simply to do their best as they commit to make a positive change.
When it comes time to speak openly and honestly about a difficult diagnosis (such as cancer) - one of the times when I want most to shield my patients from the truth - is also a time when a doctor has the utmost responsibility to be truthful.
Reality and Hope
Patients need to know what they are facing. If they are fed a lie, they will go on to live the lie.
And yet it is important to foster hope.
I once heard an oncologist say, "The one person who survives one-in-one thousand odds is one hundred percent in their own experience and one hundred percent successful- I will treat you like this person if you chose."
Balance is important when communicating with patients - especially in regards to such weighty matters. They need to be informed of their choices and it needs to be clear to them that it is their choice to make. When asked for advice in fact, I often tell patients that as long as they are honest with themselves and me, the decision they make is the right decision.
Like a marriage, a doctor-patient relationship benefits from open, honest communication. Such a relationship is essential in fostering an environment where positive health changes can be made.
Do you have this with your doctor?
Photo Credit: Big Grey Mare ~ Taking a Semi-Break