Can You Trust Your Doctor?

Posted by: Cathy Arnst on January 16, 2009

Most of us have implicit trust in our family doctor, as well we should. But the high cost of health care, increasingly limited and/or complicated insurance coverage, the doctor’s fear of malpractice, and the innate complexity and uncertainty inherent in the practice of medicine, are all fracturing that relationship.

Just look at a recent post on the blog The Skeptical OB,by OB/GYN Dr. Amy Teuter. She writes in “Your doctor made a mistake. Do you want to know?”:

I spent a delightful New Years Eve with close friends. All the adults at the party were medical professionals or lawyers and we ended up discussing a thorny medico-legal issue. What should a doctor do when he discovers another doctor’s mistake? Everyone agreed that when a patient asks a doctor directly (“Did my internist miss my cancer?”), a doctor is legally required to tell the truth. The more difficult question is what to do when a patient doesn’t ask. In that case, there is no medico-legal requirement to point out another doctor’s mistake to a patient, but is there an ethical requirement? The discussion eventually focused on “what a patient would want to know.” I suggested (okay, I argued) that a patient would want to know the same things that any doctor would want to know in a similar situation. I was surprised by the amount of resistance from the other medical professionals. They insisted, often quite passionately, that telling a patient about a mistake that cannot be fixed will upset her unnecessarily, erode trust in a doctor the patient may be still relying upon, and provide absolutely no benefit.

I don’t know about you, but I’d want to know.

So, what about the doctor who actually makes the mistake—should he or she apologize? There’s a movement, spearheaded by Dr. Lucian Leape, a professor of health policy at Harvard, to have doctors and hospitals apologize to the patient when an error is made, on the theory that it’s the right thing to do and will lessen the patient’s desire to file a lawsuit. Given that some 100,000 U.S. patients die each year due to hospital errors, it seems a valuable effort. Hospitals that have instituted the practice of apologizing, such as the University of Michigan Medical Center, have seen a dramatic drop in malpractice suits as a result. Nevertheless, in a recent issue of the magazine Medical Economics, a lawyer advises doctors to “Think Twice Before Saying I’m Sorry To A Patient.”

Physicians who admit errors may face the opprobrium of their peers, the anger and disappointment of their patients (and their patients’ families), legal entanglement, and economic loss. Unlike in church, confession doesn’t necessarily lead to absolution in the world of medicine.

It’s not just mistakes that doctors are reluctant to own up to. Doctors may be reluctant to tell patients what they need to hear, for fear that the patient will take offense. That could be one reason why, in a study published in the January issue of Pediatrics, most overweight children are not given that diagnosis by their pediatrician.

The researchers looked at the medical records of 60,000 children in the Cleveland area, and found that weight-related diagnoses were given to only 10% of the overweight patients, 54% of the obese ones and 76% of the severely obese. The researchers said that especially with patients who were overweight but not yet obese, doctors might be missing a good chance to intervene.

Of course, patients who do not trust their doctor at all, or convince themselves that some completely inappropriate course of treatment is demanded despite all medical advice to the contrary, are also a cause of the breakdown in doctor-patient trust. If your doctor tells you that antibiotics aren’t warranted for your cold, or vaccines don’t cause autism, you should listen (read the blog Respectful Insolence to keep up-to-date on what kinds of “quackery and woo,” as author Orac calls bad medical information, you should avoid).

The best way to insure quality medical care, and trust, is to educate yourself about any medical conditions you might have before you go to the doctor. Check out reliable websites like www.medscape.com or www.mayoclinic.com. And if you have a serious chronic illness, you might want to join a social network for patients (click on this BW slide show for a list).

Anyone else have some thoughts on how to improve the patient/doctor relationship?