Doctors are not always open and honest with their patients, according to a study published today in Health Affairs, making it hard for patients to make informed decisions about the best treatments and course of care.

The study uses the Charter on Medical Professionalism, which lists communication topics among its three guiding principles, as the back drop against which physician attitudes and behaviors are measured.

Despite the charter’s endorsement by more than 100 professional groups worldwide and by the Accreditation Council for Graduate Medical Education, the study claims it is unknown how widely the charter’s communication provisions are accepted or followed by U.S. physicians. This ad hoc endorsement raises doubts about the viability of broad-based patient-centered care.

Of the 1,891 physicians nationwide, about one out of 10 physicians admitted they had told patients something that was not true, according to the study. Lead study author Dr. Lisa I. Iezzoni, who also serves as director of the Mongan Institute for Health Policy at Massachusetts General Hospital,  adds that about 55% of U.S. doctor’s claim they described a prognosis more positively than facts warranted.

Half-truths and limited disclosure

Nearly 20% of physicians in the survey admitted they had not fully disclosed a medical error in the past year in part out of fear of a lawsuit, and approximately 33% did not completely agree with the need for disclosure.

The study found that general surgeons are less likely than physicians in most other specialties to report telling untruths.  Also, surgeons were significantly more likely than other physicians to agree with the need to disclose all medical errors to patients.

Also, according to the survey, more than one-quarter, 25%, of physicians reported revealing unauthorized health information about a patient—an action that goes against the Health Insurance Portability and Accountability Act of 1996 (HIPPA).

Justification or best practice

While Iezzoni says the survey cannot “unpack the reasons” why physicians act counter to the charter’s communication standards or determine whether physicians believe their reasons to be justifiable, it can help patients learn how to take more control over their health.

A physician may communicate a prognosis in a more positive way to limit a patient’s stress or protect them, says Iezzoni. Giving a patient a bad prognosis is a hard conversation, made harder if a physician and patient have a long history.

But studies show sugar-coating an illness isn’t in a patient’s best interest. In fact, cancer care research says that patients do want a truthful prognosis, and truthful conversations allow patients to confront what they need to confront in a more informed way, even beyond health like writing a will or talking to certain family members, Iezzoni says.

Not reporting or discussing medical errors—which can vary from minimal impact on patient recovery to life threatening—is sometimes justified by doctors by not wanting to heighten stress, Iezzoni says. Regardless, providing patients information enables them to better understand what went awry, and can potentially encourage them to move on.

Financial relationships

More than a third of physicians, 35%, did not completely agree that they should disclose all financial ties with drug or device manufacturers, a relationship that could cause issues based on the prevalence with which a physician recommends a particular drug or device.

Discussing these relationships may prove uncomfortable for both physicians and patients, Iezzoni says, but it is an important finding given the enactment of the Physician Payment Sunshine Act of 2009 which requires companies to begin reporting payments to physicians in excess of $10 by March 2013.

Once this data become public, some physicians will probably encounter patients who wish to discuss potential financial conflicts of interest, the study says. 

The survey does suggest that while many physicians do not completely support the charter’s communication requirements, treating the charter precepts as “black or white” may fail to recognize the complexities of patient-physician communication in everyday practice.