To lie or not to lie: resident physician attitudes about the use of deception in clinical practice.

BACKGROUND

Physicians face competing values of truth-telling and beneficence when deception may be employed in patient care. The purposes of this study were to assess resident physicians' attitudes towards lying, explore lie types and reported reasons for lying.

METHOD

After obtaining institutional review board review (OSR# 58013) and receiving exempt status, posts written by Loma Linda University resident physicians in response to forum questions in required online courses were collected from 2002 to 2007. Responses were blinded and manually coded by two investigators using NVivo software. Qualitative and quantitative analyses of the data were performed with links to various attributes. A 95% binomial proportion CI was used to analyse the attribute data.

RESULTS

The study found that the majority of residents (90.3%) would disclose the truth about medical errors. Similarly, many residents (55.7%) would disclose the truth regarding unanticipated events, especially if the error was serious enough to result in a malpractice suit (74.7%). However, many residents (40.9%) would not reveal a near miss event because they believe it has no impact on patient health. Some residents (47.3%) would deceive the insurance company for additional patient benefits. Of those willing to lie, only a small group (4.2%) gave self-serving reasons.

CONCLUSIONS

This study demonstrates that the ethical issues related to deception that trouble attending physicians also exist at the resident physician level. Residents primarily lie for altruistic reasons and rarely for egoistic or self-serving purposes that may or may not result in harm to patients, insurance companies and/or physicians themselves.