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Honesty is still the best policy


The right thing to do is rarely the easiest option.

I can recall medical school courses such as Doctoring 101, where the framework of patient-centered care was taught to first-and second-year medical students. We were naïve in our patient-care skills, but supremely confident that we could learn to provide thoughtful, open, and 100% honest care.

There were role-playing sessions in which we handled different patient personalities, dealt with patients of different religious beliefs, chose the right empathic words to say to a family experiencing the loss of a loved one, or said "I'm sorry" in cases of an undesirable medical or surgical outcome. We knew it was the right thing to do,1 and it was the required thing to do.2 By the time we hit the wards, we were ready to be expert communicators.

In the real world, we are often quick to come up with many persuasive justifications to avoid full disclosure:

In addition, adverse outcomes lead to fears of lawsuits. Suddenly, admitting to a medical error, or even apologizing, seemed a bit more dangerous-an implied admission of guilt. Finally, there was the occasional doctor still holding on to the days of paternalistic, doctor-knows-best, medicine.

With time and experience, we learned to manage this tension (though the thought of a lawsuit still scares us all), and strove to uphold the principles of Doctoring 101. In today's litigious climate, we also learned (and studies have shown3 ) that deceit on the part of the physician leads to anger on the part of the patient, with a lawsuit more likely to follow soon after.

On the other hand, effective and respectful communication-including listening to patients-increases the chances that patients will understand that accidents happen; they will appreciate the truth, and, we hope, forgive.

Look around your hospital-how does this tension play out? Is there a disparity between what we know to be right and what is actually done?

How well has the Fusarium keratitis outbreak been handled? With the investigation ongoing, we all have an opportunity to analyze how the principles of patient-centered care, and the rules of open and honest communication, apply to large corporations.

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