{"id":17958,"date":"2018-12-03T10:56:56","date_gmt":"2018-12-03T15:56:56","guid":{"rendered":"http:\/\/thepapergown.zocdoc.com\/?p=17958"},"modified":"2023-03-03T15:01:33","modified_gmt":"2023-03-03T20:01:33","slug":"1-question-5-answers-when-do-doctors-withhold-information-from-patients","status":"publish","type":"post","link":"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/","title":{"rendered":"1 Question, 5 Answers: When Do Doctors Withhold Information From Patients?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">For a 2012 <\/span><a href=\"https:\/\/www.healthaffairs.org\/doi\/abs\/10.1377\/hlthaff.2010.1137\"><span style=\"font-weight: 400;\">study<\/span><\/a><span style=\"font-weight: 400;\">, Harvard Medical School professor Lisa Lezzioni surveyed 1,891 physicians about their views on disclosing information to patients. Roughly one-third indicated they might not always divulge medical errors. Nearly 40 percent wavered when asked if they\u2019d lay bare their relationships with drug and medical device companies. Almost 20 percent didn\u2019t agree that they should never tell a patient something untrue. In fact, 10 percent admitted they\u2019d done exactly that within the past year. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Doctors often become arbiters of what a patient knows about their own health. They break down complex diagnoses into relatable terms, walk patients through treatment options and answer questions about recovery outcomes. In deciding which details to share and when, doctors are always performing a balancing act between equipping patients with enough knowledge and burdening them with too much. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">To better understand how, why and when physicians choose to withhold information from patients \u2014 even if only temporarily \u2014 we spoke with four doctors and one medical ethics expert. Here\u2019s what they had to say. <\/span><\/p>\n<h3><a href=\"https:\/\/med.nyu.edu\/faculty\/arthur-l-caplan\"><span style=\"font-weight: 400;\">Arthur Kaplan, PhD<\/span><\/a><\/h3>\n<p><em><span style=\"font-weight: 400;\">Professor of bioethics, Department of Population Health, New York University Langone Health<br \/>\nNew York City<\/span><br \/>\n<\/em><\/p>\n<p><span style=\"font-weight: 400;\">The general principle is to never shield patients from information. Patients have a right to know. But there are a lot of ways to share information, and what you don\u2019t want to do is boggle someone\u2019s mind with the ins and outs. You\u2019re not withholding, but you\u2019re making things more comprehensible. Sometimes it\u2019s bad news. You\u2019re sharing it, but you may not want to do it until a spouse comes or you can do it in person. You want to be able to support a patient better. That\u2019s ethically defensible because you\u2019re not withholding the information forever. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">The other instance would be doctors who feel that they shouldn\u2019t share information because it might harm someone\u2019s ability to remain in the country. You might not tell someone the results of a test because you don\u2019t think they\u2019re the person they\u2019re claiming to be. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another major issue is comprehension. The first time you tell someone they have cancer, they don\u2019t hear anything after that. Sometimes you need to discuss things with them over a few visits until it sinks in. <\/span><\/p>\n<hr class=\"squiggle\" \/>\n<h3><a href=\"http:\/\/sandeepjauhar.com\/\"><span style=\"font-weight: 400;\">Dr. Sandeep Jauhar, MD, PhD<\/span><\/a><\/h3>\n<p><em><span style=\"font-weight: 400;\">Author of <\/span><\/em><span style=\"font-weight: 400;\">Doctored: The Disillusionment of the American Physician<\/span><span style=\"font-weight: 400;\"> and <\/span><span style=\"font-weight: 400;\">Heart: A History<\/span><em><span style=\"font-weight: 400;\"><br \/>\n<\/span>New York City<\/em><\/p>\n<p><span style=\"font-weight: 400;\">There was a situation where a patient of mine appeared very upset about a diagnosis of having congestive heart failure, and his father said it would mean a lot to him if I didn\u2019t tell his son everything up front. I approached it in a way where I conveyed information over several days. This wasn\u2019t misleading or withholding information, but presenting it in a way that a sick patient was best able to process.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The paternalistic approach that worked in the 1950s is not something we do now. In the case of risks, I recently recommended a scan to a patient and she asked about side effects. I told her that there were minimal side effects based on my experience. I didn\u2019t go through every potential idiosyncratic side effect the scan\u2019s [injected] tracer dye might have. Most patients don\u2019t want an exhaustive compendium of potential side effects of treatments they\u2019ve adopted. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">If a patient has dementia, cognitive impairment or depression, you have to take that into consideration as well. Sometimes patients lack the capacity to fully understand and refer you to their healthcare proxy. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">If they have something concerning, like a testicular lump, even if I think it might be cancer, I\u2019ll say, \u201cLet\u2019s wait and see.\u201d I might be wrong and there\u2019s no point in worrying the patient, especially when no treatment is offered until the diagnosis is made. <\/span><\/p>\n<hr class=\"squiggle\" \/>\n<h3><a href=\"http:\/\/www.ronaldepstein.com\/\"><span style=\"font-weight: 400;\">Dr. Ronald Epstein, MD<\/span><\/a><\/h3>\n<p><em><span style=\"font-weight: 400;\">Medical school professor and director of the Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry<br \/>\nRochester, NY<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">For any symptom, there can be several dozen possible explanations. Some of them are pretty ordinary and some are frightening. For every person who has a headache, I don\u2019t necessarily mention the possibility of a brain tumor if the symptoms don\u2019t add up to it.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Sometimes families of patients will ask you not to say anything. That can be cultural. There are stereotypes about that, like some of them not wanting you to disclose a cancer diagnosis, but that\u2019s changing. If that happens, I\u2019ll ask them why, or something like, \u201cDon\u2019t you think your loved one would want to be involved in this decision?\u201d Or a family member might ask me to talk about the diagnosis but not about how bad it is. I\u2019ll say, \u201cWell, I don\u2019t know how bad it will be, but I need to be honest about what I know and what I don\u2019t.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">I\u2019ll ask patients how much they want to know. I do palliative care, and if someone has four metastases or five, the outcome is not going to be any different. Then I might wait for the patient\u2019s cue if they want more information. It varies from person to person. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">For side effects, if they\u2019re likely to be present in 10 percent of people or more, I\u2019ll disclose. That 1 to 10 percent is often a very long list. If it\u2019s under 1 percent, I\u2019ll mention it only if it\u2019s a rare and life-threatening complication. <\/span><\/p>\n<hr class=\"squiggle\" \/>\n<h3><a href=\"http:\/\/drlinda-md.com\/\"><span style=\"font-weight: 400;\">Dr. Linda Girgis, MD<\/span><\/a><\/h3>\n<p><em><span style=\"font-weight: 400;\">Family medicine physician and author of <\/span><\/em><span style=\"font-weight: 400;\">The Healthcare Apocalypse<\/span><em><span style=\"font-weight: 400;\"><br \/>\n<\/span><span style=\"font-weight: 400;\">South River, New Jersey<\/span><br \/>\n<\/em><\/p>\n<p><span style=\"font-weight: 400;\">If an adult is cognitively impaired, a responsible adult should pursue a legal document making them medical proxy before a serious healthcare condition arises. But if that didn\u2019t happen, the physician needs to assess the patient\u2019s cognitive state. If they are able to comprehend the information, we must tell them everything, no matter what others request of us. The patient always has the authority and right to know.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It is never acceptable to withhold or delay giving a patient medical information. That information belongs to them. As doctors, we must learn how to give information with compassion and respond to any concerns or questions that may arise. Patients may become distressed, but we must know how to handle that distress. Also, how do we know how anyone will respond to disturbing news? It is not right to predict this from our own senses and biases. I have often been amazed at how patients face devastating news with great courage. It is not the doctor\u2019s right to make the decision of how much information to release on behalf of the patient. <\/span><\/p>\n<hr class=\"squiggle\" \/>\n<h3><a href=\"https:\/\/www.urmc.rochester.edu\/people\/23067752-timothy-edward-quill\"><span style=\"font-weight: 400;\">Dr. Timothy Quill, MD<\/span><\/a><\/h3>\n<p><em><span style=\"font-weight: 400;\">Professor of medicine and palliative care, University of Rochester Medical Center<br \/>\nRochester, New York<br \/>\n<\/span><\/em><\/p>\n<p><span style=\"font-weight: 400;\">These judgments are made all the time. One cannot possibly discuss every possible approach and bit of information because it would take too much time and be confusing. Critical information should never be unilaterally withheld. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">If a family member requests to withhold information, my answer would always be that I will be honest if a patient asks directly or seems to want to know, provided they\u2019re able to think clearly and are not actively suicidal or have a major cognitive impairment. You might need a psychiatrist to help in difficult cases. Emotional and cognitive fragility needs to be considered. I would keep it simple and perhaps not even [share information] if they did not have the ability to comprehend. That would be after a discussion with the family and with others on the treatment team.<\/span><\/p>\n<hr \/>\n<p><i>Responses have been condensed and lightly edited.<\/i><\/p>\n<hr \/>\n<h1 class=\"p1\" style=\"text-align: center;\"><span class=\"s1\">Ready to book a doctor&#8217;s appointment? Visit <a href=\"https:\/\/www.zocdoc.com\/\"><span class=\"s2\">Zocdoc.<\/span><\/a><\/span><\/h1>\n","protected":false},"excerpt":{"rendered":"<p>Should patients always hear the whole, unfiltered truth? 5 experts weigh in. <\/p>\n","protected":false},"author":24,"featured_media":18174,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[228],"tags":[6,108,119,56],"class_list":["post-17958","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-advice","tag-1q5as","tag-doctors-and-patients","tag-ethics","tag-primary-care","reviewer-dr-nassim-assefi"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>1 Question, 5 Answers: When Do Doctors Withhold Information From Patients? - Advice<\/title>\n<meta name=\"description\" content=\"Should patients always hear the whole, unfiltered truth? 5 experts weigh in.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"1 Question, 5 Answers: When Do Doctors Withhold Information From Patients? - Advice\" \/>\n<meta property=\"og:description\" content=\"Should patients always hear the whole, unfiltered truth? 5 experts weigh in.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/\" \/>\n<meta property=\"og:site_name\" content=\"The Paper Gown\" \/>\n<meta property=\"article:published_time\" content=\"2018-12-03T15:56:56+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-03-03T20:01:33+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/zocdoc.com\/blog\/wp-content\/uploads\/2019\/04\/HeroOchre5Answers.png\" \/>\n\t<meta property=\"og:image:width\" content=\"968\" \/>\n\t<meta property=\"og:image:height\" content=\"452\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Jake Rossen\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Jake Rossen\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/\"},\"author\":{\"name\":\"Jake Rossen\",\"@id\":\"https:\/\/www.zocdoc.com\/blog\/#\/schema\/person\/134520335bffbc4e59bce2791911e25d\"},\"headline\":\"1 Question, 5 Answers: When Do Doctors Withhold Information From Patients?\",\"datePublished\":\"2018-12-03T15:56:56+00:00\",\"dateModified\":\"2023-03-03T20:01:33+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/\"},\"wordCount\":1297,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\/\/www.zocdoc.com\/blog\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/thepapergown.wpengine.com\/wp-content\/uploads\/2019\/04\/HeroOchre5Answers.png\",\"keywords\":[\"1Q5A's\",\"Doctors &amp; Patients\",\"Ethics\",\"Primary Care\"],\"articleSection\":[\"Advice\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/\",\"url\":\"https:\/\/www.zocdoc.com\/blog\/advice\/1-question-5-answers-when-do-doctors-withhold-information-from-patients\/\",\"name\":\"1 Question, 5 Answers: When Do Doctors Withhold Information From Patients? 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