Why your doctor doesn’t always tell you the truth
Medicine has historically been about disguising, sanitising and spinning the truth. Dr Phil Hammond explains why honesty is not always the best medicine<‘We assume you don’t want the whole truth because it isn’t compatible with trust’
One reason you trust doctors is because you think we tell you the truth.
But medicine has historically been about disguising, sanitising and spinning the truth. Gently coercing you into the treatment we think is best. All for your own good.
We assume you don’t want the whole truth because it isn’t compatible with trust. Generally, it’s not considered sensible to tell you how much we doctors drink, how inexperienced we are or how physically attractive or repugnant we find you. And especially not what your front bottom looks like after childbirth.
When I first walked onto an NHS ward in 1984, many patients were not even told if they had a serious diagnosis such as cancer, multiple sclerosis or dementia. We assumed you weren’t able to contribute, didn’t want to know or that telling you might just make you more anxious and unable to cope. And doctors didn’t have to waste emotion and energy on those difficult conversations about death and disability. But not knowing your diagnosis meant that you couldn’t possibly participate in important decisions about your care, involve your loved ones or plan properly for the future. We pretended to do the worrying for you, and left you to figure it out for yourself.
If you were lucky, we might treat you to a euphemism.
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- Why are men’s sperm rates falling?“You’ve got a little bit of a problem down below” means “a grenade’s gone off in here”.“You may feel a bit of gentle prodding” means “I take a size 18 glove”.
“Yes of course I’ve done one of these before” means “I’ve seen it on ER”.
“You’ve got a spot on the lung” means “you’re going to die”.
“It’ll get a little worse before it gets a little better” means “you’re going to die today“.
“It’s probably a virus” means “go away”.
“It’s probably a virus but we’d better examine you anyway” means “you have fabulous breasts”.
“Take this drug and your risk of death will be slashed by 40pc” means “if you swallow 1,825 of these over five years and at a prescription cost of £500, your risk of death would fall by 0.9pc. The recognised side effects are muscle damage, headache, abdominal pain, nausea, vomiting, hairloss, anaemia, dizziness, depression, nerve damage, hepatitis, jaundice, pancreatitis and hypersensitivity syndrome”.
Doctors are human, so we make mistakes, act in our own best interests and give biased advice. One way to inoculate yourself against this is to seek out and understand the scientific evidence behind what we say, rather than taking it at face value. Senseaboutscience.org is a good place to start.
Five doctors often give five different opinions. Are four of them lying or just ill-informed? Remember also that disguising the truth is a two way street. Patients lie to doctors as much as we lie to you.
“I eat like a sparrow” means “like an 18-stone sparrow”.
“I always wear a condom” means 2on my head at parties”.
“I exercise regularly” means “if you count masturbation”.
“I’ve only just noticed the lump” means “I’ve been living in terror for the last six months and I’m only here now because it’s started to smell”.
Medicine is a performance art, more soft spin than hard science. It gets much harder if you insist on the absolute truth, but that’s what is about to happen thanks to assorted medical scandals. Traditionally, politicians lie about the state of the NHS, both in power and in opposition, and the lies get passed down the line. Bad news and unlucky patients are buried before an election and then resurrected at a lengthy public inquiry years later. But now – thanks to something called a duty of candour – NHS staff are obliged to tell you if you have probably been harmed by your care. Even before an election.
We know from research in many countries that around one in 10 patients are harmed by hospital care, and the sicker you are the more likely you are to suffer what is touchingly called “an adverse event”.
We’re not sure what the figure is in primary care, but it’s likely to be similar. It’s also likely that many cases of harm pass us by without us even noticing. Medicine is fast moving and the demands are huge, and we often don’t have the time to reflect on whether a patient may have been harmed by care, particularly as patients often won’t bring it to our attention. And often the harm isn’t clear cut – there is significant doubt as to what may have caused it.
When we do spot harm, or likely harm, the fear is always that we may be blamed or punished if we own up. I’ve sat in many audit meetings over the years, both in hospital and general practice, when serious harm has gone unnoticed by patients and relatives and the response has been a collective sigh of silent relief, rather than a sense of duty to tell the truth. But all this is supposed to have changed now.
Finally, patients will be told the truth about the limits and harms of medicine, as well as it benefits. The theory is that honesty, apology and a plan to stop other patients suffering will be enough to settle most cases without the need for lawyers. But with a fifth of the entire NHS obstetric budget going on litigation, the worry is that the new culture of honesty in the NHS will just allow lawyers to bleed it dry. We shall see. Happy New Year.
For Dr Phil’s new book, What Do Doctors Really Think, and his ‘telling the truth’ pre-election tour dates go to drphilhammond.com