Health system leaders who are retooling medical practices to deliver patient-centered care need to add an important item to their to-do list: Instruct physicians to be honest with their patients.
Patient-centered care relies on physicians' communicating openly and frankly so that patients understand their medical situations and their options, says Lisa Iezzoni, M.D., a Harvard Medical School professor and director of the Mongan Institute for Health Policy at Massachusetts General Hospital.
Absent that candor, "patients will not be able to make the most informed decisions about their care in the way that reflects their preferences and values," she says.
But a large physician survey conducted by Iezzoni and her colleagues found that a majority — 55 percent — had described a patient's prognosis in a more positive manner than warranted within the past year. And 11 percent of the physicians said they had told an adult patient or a child's guardian something that was not true during that period.
Those behaviors appear to reflect physicians' beliefs. Roughly 88 percent of respondents "completely agree" that physicians should fully inform all patients of benefits and risks of procedure or course of treatment, and 83 percent fully concur that physicians should never tell a patient something that is not true.
The survey was published in Health Affairs earlier this year. Harold Sox, M.D., who serves on the board of directors of the Informed Medical Decisions Foundation, suspects that the findings reflect the fact that older physicians — more than 60 percent of respondents have been in practice at least 20 years — were trained during a time when medical practice was more authoritarian or paternalistic than it is now.
"That era has given way to an era in which physicians increasingly recognize that the deepest principle of all is that patients are in charge of their own bodies and that physicians shouldn't presume what they think or they want," says Sox, an internist and former editor of the Annals of Internal Medicine. "Patients need truthful information to make decisions."
He believes that shared decision-making, a key component of patient-centered care, requires physicians to have time for candid conversations with their patients. Thus, hospitals that own medical practices may encourage more open communication with patients by changing workflow in a physician's office.
The survey did not explore how frequently physicians fudge the truth or how they justified doing so. But the fact that more than half of physicians admitted giving rosier-than-warranted prognoses gives Iezzoni pause.
"At the end of the day, patient-centered care really requires patients to have complete and accurate information," she says. "That number bothers me."