Little white lies

 I’m tempted to buy a copy of Dr. Michelle Au’s new book for the title alone: “This Won’t Hurt a Bit (and Other White Lies): My Education in Medicine and Motherhood.”

Aha! Someone in health care actually is publicly admitting they’re not always truthful with patients.

The practice of fudging the truth seems to have a rather long history in medicine. Once upon a time it wasn’t unusual to sugarcoat or withhold bad news – not telling a patient of a cancer diagnosis, for instance, or characterizing the cancer as a “growth” rather than a malignancy.

When health care professionals have done this, it has generally been with good intentions. Often it’s because they don’t want to unduly frighten or discourage the patient. Sometimes they simply don’t want to overwhelm a layperson with too much information or complexity.

And sometimes, let’s face it, a little white lie or two just makes it easier to manage the patient. We’ve all heard the fibs, and I would guess most of us haven’t been fooled by them:

- “The doctor will be with you shortly.” Translation: “Find a good magazine to read because it’s going to be awhile.”

- “This may sting a little.” Translation: “This is definitely going to sting a whole lot.”

- “I’ve never had a patient vomit/pass out/die from this procedure.” Translation: “None of the above has happened to me yet but there’s a first time for everything.”

- “I don’t want to alarm you.” Translation: “Be alarmed. Be very, very alarmed.”

Is it ever OK to be not entirely truthful with patients, even in a minor situation? Even if a little dishonesty seems to be in the patient’s best interests?

Ethicists have debated this issue extensively. While it’s generally agreed that truth-telling belongs at the heart of the patient-clinician relationship, there are a lot of gray areas. One example: smoothing over the truth to help an elderly patient avoid becoming overly upset or exposed to information they don’t need to know. There’s actually a name for this – the “geriatric fiblet” – and it can be deployed in a variety of situations, such as concealing information from an older person at the request of their adult children.

What about some of the deeper ethical complexities? How truthful can clinicians be in the face of medical uncertainty? What if the patient explicitly says he or she doesn’t want to know certain information?

The right thing to do can sometimes depend on the circumstances. In general, though, the foremost principle should be to preserve the patient’s autonomy, explains an article published last month by the Center for Health Ethics at the University of Missouri School of Medicine:

Ordinarily physicians and other providers are considered to be bound by obligations to the patient of respect for patient autonomy, acting for the benefit of the patient, and refraining from anything that would harm the patient. Truth-telling or honesty is seen as a basic moral principle, rule, or value. Withholding information or otherwise deceiving the patient would seem to at least disrespect patient autonomy and potentially harm the patient. Respecting patient autonomy means allowing patients to make their own decisions about whether to have certain tests, procedures, or treatments, or other interventions recommended by the healthcare provider. It means allowing patients to be in control of their lives to the extent possible. But no one can be in control of their healthcare decisions and lives if the choices are being made on the basis of significantly incomplete information or outright deception.

Here’s something else to consider: When clinicians tell little white lies, are they also more likely to fib when it comes to larger issues?

Since we’re talking about honesty, there definitely are times in health care when patients would probably rather not hear the blunt truth.

Several years ago I had to undergo a throat swab for what later turned out to be strep throat. The swab in the lab technician’s hand looked like it was a mile long. I was not thrilled about it, and I could feel my gag reflex getting ready to activate. “Is this going to make me vomit?” I blurted out.

The tech could have told a white lie – “Oh, no, you’re going to be just fine” – but she stuck to the truth: “You might” was her reply.

At the moment, it wasn’t exactly a reassuring response. On the other hand, at least I had a realistic idea of what to expect and was ready for it. And guess what? I appreciated that she was straightforward with me. (The throat swab went fine, in case anyone is wondering.) A little honesty, even in the small things, can go a long way.

How do readers feel about white lies told by health care providers? Do you think they’re OK in certain circumstances, or would you rather have total honesty? Please share your thoughts in the comment section.

5 thoughts on “Little white lies

  1. I’ve mostly found the little “Oh, It’s nothing.” or “we’ll keep an eye on it” as my biggest issue. Come on, if I’m bothered by something, I’m going to tell you about it, if I’m not, you’ll never hear about it. The term “nothing” is not in any of the medical books I’ve read in school.

  2. After spending 3 weeks in the hospital and then seeing my son spend 65 more days, I learned to cut through the sugar coating and get the straight answer immediately. By the end of the first week they didn’t even bother. I could always tell when I had a doctor who i hadn’t worked with yet because they’d always be left fumbling when I’d say, “Just tell me the truth now so we can be proactive.” I was told later I was ‘advocating’ for myself and my son by encouraging tests etc. I called it playing ‘mad scientist’ because the doctors were so busy looking on the bright side that they would delay testing.

  3. I’d always rather know. I do not like surprises.

    My dentist always warns me when something is going to hurt, and I appreciate it, because I can steel myself against it a bit.

    I think my exact words are usually something like “UNNNNHHH.”

    My mom (an RN) is also in the habit of telling the full truth about such things, and it always makes everything so much easier. You know exactly what to expect.

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