Friday, February 10, 2012

White Lies / Black Sin

I read a recent article about a study that found a strikingly large number of health care providers are not completely honest with their patients when it comes to mistakes. The study also found doctors frequently tell white lies when it comes to full disclosure of test findings and diagnoses. You can read the article here.

I have a somewhat applicable perspective of being both a health care provider and a patient, so I was interested in the dynamics of the study. It appears that over 55% of doctors have been more positive about a prognosis than tests warranted and over 10% have told patients something that simply isn’t true. Over 30% believe it is acceptable to withhold medical mistakes from patients and a comparable number believe it is OK to abstain from revealing financial ties to drug companies or medical device companies.

I was quite surprised by the numbers and would expect they are even higher than reported as most folks aren’t even completely honest in anonymous surveys! However, I would like to dissect the findings from two different perspectives and try to bring those two perspectives together into a clear example of the power of sin in our lives and in our relationships.

First, I think it is important to consider that most doctors become doctors to help people. Most doctors are also very smart. But, wanting to help people and being smart doesn’t make one a good communicator. The article does a good job of contextualizing the circumstances where white lies seem reasonable. I see this in my office everyday. Obviously, as an optometrist, I don’t have to tell people bad news all the time. That is one reason I chose optometry over medicine. However, on occasion, I do have to tell folks that they are going to go blind. Blindness, like many conditions, doesn’t typically happen overnight. Therefore, it is not uncommon for a doctor to perform various tests over time to allow a condition to declare itself before completely revealing the condition to the patient.

Most medical ethicists consider this approach to be practical medicine. It is equivalent to simply “wanting to be sure” instead of perpetually worrying the patient if the tests actually reveal the findings to be normal after all. The only thing more unsettling than being told you are going blind is being told that you are going blind and then sometime in the future being told that you are now, in fact, not going blind! It is absolutely amazing how many of my patients are on anti-anxiety medications and we as providers must be cognizant of how our communication affects the whole person in context.

The article does broach the topic of financial interests in products and treatments. It is common practice for a healthcare provider or researcher to reveal any financial interests when presenting case reports or research. Therefore, I consider it reasonable to also reveal those interests to patients. I believe that to be an ethical and moral responsibility. I believe it is also an ethical and moral responsibility to reveal medical mistakes to a patient. The article states the most common reason for not revealing mistakes is fear of litigation.

If we look at these two issues in a biblical context, we begin to see the common thread of fear weaving back and forth within the patient - doctor relationship. The type of fear that leads to anxiety is the same kind of fear that leads to white lies. Anxiety is the fear of losing control. Lies are considered necessary to maintain control. Both are sin.

In this commonality of fear, I believe we can see another clear example of how our view of the gospel truly affects our daily decisions. Consider an anxious patient who filter’s unexpected news through the truth of the gospel. No one wants to hear bad news, but those who are willing to lose their life to gain it simply are not as upset to find they may actually lose it. Consider a physician that has come to terms that only the Great Physician can truly heal eternally. That physician knows full well the fear of failure and the pursuit of control leads to misrepresentation and a breach of trust. Now, place those two individuals in a room together working together to come to an understanding of a condition and you can see a very practical picture of the power of the gospel overcoming the power of sin.

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