B. You're about to hear an interview from National Public Radio's Saturday morning program, Weekend Edition.
NPR host Liane Hansen asks two doctors several questions during the discussion.
Listen carefully and fill in the charts with the key words on each doctor's general response to the interviewer's questions.
Trust was a word that was used early and often during the campaign, and when it comes to the politicians, people really must think about whether they can trust their representatives to represent them.
But when it comes to the relationship between a patient and doctor, the word trust should be a given. Doctors are, after all, supposed to do what's best for us and this involves telling the truth.
However, on occasion, a doctor must choose between being truthful and acting in the patient's best interest.
We asked our medical commentators, Dr Michael Wilkes and Miriam Shuchman to join us with their opinions on this subject. Good morning to both of you.
Good morning, Liane. Miriam, when might a doctor choose not to tell a patient the truth?
Well, Liane, there are actually several situations when a doctor might be tempted to deceive a patient.
It used to be that if a patient was diagnosed with a serious form of cancer, the doctor wouldn't even tell them. That wouldn't happen anymore...
But the doctor might be tempted to paint a more optimistic picture than is really the case, so if this was a cancer where the patient has three to six months to live, the doctor might not tell them that.
They might just tell them that it's very serious.
My worry, though, is that doctors might also paint a more rosy picture in order to convince a patient to undergo a more aggressive treatment, say, say chemotherapy, a treatment that they might not under or choose to undergo if they had more information.
To, to me, uh, there really is no distinction between withholding information from a person and outright lying.
In both cases, the doctor is being paternalistic. He's deciding what information the patient needs to know.
I think that as doctors, though, we're always in the postion of deciding what information to give a patient.
We don't want to overburden them with too many details that could just be frightening and not useful.
But we want them to have the information that's really important for making decisions.
Yeah, but can you ever really know what a patient thinks is important?
Every piece of information that a doctor gives a patient is filtered through a doctor's filter, a filter that includes cultural bias, religious bias, economic bias, and their own personal values.
And there's some very compelling data that sick people really want much more information about the condition than they're currently being told.
Michael, have you ever been tempted to be less than perfectly honest with a patient?
Absolutely. There's always that temptation, Liane.
Telling the truth in medicine is one of the most difficult things to do.
The...uh...there is an issue that came up recently when another physician suggested that I prescribe a placebo, or a sugar pill that had no biological effects for a patient.
A 70-year-old man had just moved to town and he came to see me to get a refill of prescription for a sleeping pill that he'd been given for a long time.
In fact, it turned out he'd been taking the pill every night since his wife died several years ago.
As I spoke with him, it became clear to me that he recognized that he was addicted to the sleeping medicine.
In fact, he said he wanted to stop, but every time he tried to stop taking the medicine, he couldn't sleep and ended up taking the sleeping pill.
Now, a doctor at the hospital suggested that I use a placebo.
He said that he'd had great luck using this type of placebo for exactly these types of addictions.
The problem was that there was no way that I could use the placebo without deceiving the patient.
So the issue here for me was whether doctors are justified in telling this sort of little white lies in order to benefit the patients.
Miriam, as an ethics specialist, what do you say? What does medical ethics tell us is right in the situation?
Well, I think the conflict for the doctor here is that he's really seeing two duties.
One is not to lie to a patient, and the other is, uh, to always do what's beneficial for the patient, not to do the harm.
So in this case, the doctor who suggested the placebo may think that it's most beneficial to prescribe placebo.
It won't have any side effects, uh, and the little white lie he thinks is not as important.
So should people be concerned that, uh, when they go to their doctor, that the doctor might be prescribing a placebo?
Absolutely not. First, the use of placebos in clinical practice is very rare.
They're mostly used in research where people are told they're going to be receiving a placebo.
And second, there are doctrines and policies around this.
It's called informed consent, and what it means is that before a patient can agree to a given treatment or procedure, the doctor is obliged to inform them about the risks and benefits about of that treatment, and most doctors are aware of that.
You know, it's probably worth mentioning here that experts feel that about 30% of medicines that we currently prescribe really have no biologic activity.
They work through the power of suggestions.
Um, cough medicine are a great example of this sort of drug.
Now, that doesn't mean that cough medicines don't work.
What I am trying to suggest is that they work through an effect on the mind rather than on the body, say, on the diaphragm or in the lung tissue or muscles themselves.
Anyway, I feel there are still far two many times when doctors really aren't being truthful with patients because they feel that they know what's best for the patient.
We talked about placebos, but what about lying?
How often do doctors lie to their patients?
Liane, I can't give you a statistics on that but I don't think it happens very often. Doctors don't intentionally mislead their patients.
But what does happen is that patients aren't given the information they really need to make decisions.
Doctors don't give them the chance to ask the questions that would get them that information.
Michael, what happened to the man that was hooked on the sleeping pill?
Liane, we talked about it for a long time at the hospital.
The bottom line was I, uh, I chose not to use a placebo.
The downside of that decision is that the man is still addicted to the medicine although I'm slowly weaning him off by using some behavior modification techniques.
Weekend Edition medical commentators Dr Michael Wilkes and Dr Miriam Shuchman.