Is honesty really the best policy?

Every American pupil is familiar with the story of the George Washington who, as a 6 year old, received the gift of a small hatchet. In a sequence of events, chronicled by the author Mason Locke Weems, the young George promptly put his tool into action in the family garden:

"George," said his father, "do you know who killed that beautiful little cherry tree yonder in the garden? "This was a tough question; and George staggered under it for a moment; but quickly recovered himself: and looking at his father, with the sweet face of youth brightened with the inexpressible charm of all-conquering truth, he bravely cried out, "I can't tell a lie, Pa; you know I can't tell a lie. I did cut it with my hatchet." "Run to my arms, you dearest boy," cried his father in transports, "run to my arms; glad am I, George, that you killed my tree; for you have paid me for it a thousand fold. Such an act of heroism in my son is more worth than a thousand trees, though blossomed with silver, and their fruits of purest gold."¹

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The lesson garnered by children from this story is that honesty is a virtue and strength, admired by others, and a predictor of greatness. While many parents want their children to inculcate this life lesson, there are two caveats that we should keep in mind. One is that Weems' testimony to George's veracity is thought to be pure fabrication². Caveat number two is that, if George Washington was nonetheless a scrupulously honest political leader, he was apparently the last. According to noted political science historian Rupert Pupkin, when cornered by a direct question whose truthful answer would be embarrassing, successful politicians will prevaricate 97.3% of the time.³

Here are just a few famous examples:

"I am not a crook." - Richard Nixon in televised speech

"I did not have sex with that woman, Miss Lewinsky." - Bill Clinton in televised speech

"Russia is not going to try to annex Crimea." - Vladimir Putin to BBC

"If you like your doctor you can keep your doctor. If you like your health care plan, you can keep your health care plan." - Barack Obama

It is-quite frankly-hard to prove that honesty is the best policy when it comes to a political career. At least in my country, as succinctly and eloquently expressed by another famous American, the pioneer Davy Crockett, for two centuries the public has come to expect dishonesty from these folks:

“There ain't no ticks like poly-ticks.  Bloodsuckers all.” - Davy Crockett 

But what about for physicians?  Is truthfulness an advantage and is it expected of ophthalmologists and other doctors?  According to Dr. James Drane⁴:

"Honesty also matters to the doctor and other medical professionals. The loss of reputation for honesty in medical practice means the end of medicine as a profession. Important as it is for patients and doctors, however, honesty has been neither a major concern in medical ethics nor an important value for doctors. It may be an exaggeration to say that honesty is neither taught in medical school nor valued in medical culture, but it is not too much of an exaggeration."

For example, should an ophthalmologist tell his or her patient:

1.  About a minor surgical complication even if it may not prevent a good outcome and the patient would never know?

2.  That he or she has not performed many of the procedures that the patient is about to have?

3.  That a resident or fellow will perform the key parts of the surgery under the attending's supervision?

Given the choice, I must admit, I would prefer an honest doctor. I lost all respect for a surgeon who lied in the effort to cover up a serious surgical complication when he operated on a family member. But, I’d have great respect and sympathy for a doctor whose patient had a bad outcome and the doctor immediately owned up to the problem.

1.  ML Weems:  The Life of Washington.  1800

2.  Is it all right to make up stories about real people in order to teach children about honesty?  In the 19th century, some people thought so.  TeachingHistory.org

3. I made this up.

4.  http://www.uchile.cl/portal/investigacion/centro-interdisciplinario-de-estudios-en-bioetica/publicaciones/76983/honesty-in-medicine-should-doctors-tell-the-truth