As kids when we did something wrong and were confronted with it our first reaction was to deny it. It definitely did not do any good as our parents or the authority figure over us knew better and by denying it, it only made things worse.

As an adult I don’t think much has changed. When we make a mistake, especially a major mistake, our natural reflex is to try to cover it up or explain it away. This week in JAMA ( Journal of the American Medical Association) there was an interesting article titled Mistakes. In the article the physician had given a group of 30 medical students a hypothetical case in which a patient, a young man, was given the wrong injection by his physician to treat syphilis. After determining that no harm would come to the patient the students decided that the physician should simply order the correct treatment without revealing his initial error. A third year student suggested a plausible (but false) justification for the extra injections required to correct this mistake. Full disclosure would benefit neither physician nor patient, the group rationalized. In fact, they thought honesty would imperil the patient’s trust in his physician. The students reached this conclusion in just a few minutes with no discernible dissent.

The physician went on to explain,” what bothered me most, I suppose, was the ease with which a group of medical students defended a kind of deception. Or not the ease, exactly, but the rationale: their idea that the physician’s status mattered more than honesty-and that the patient’s trust in his physician depended on an illusion of perfection, of inviolability.” He went on to explain that these medical students attended a very prestigious medical school where scientific integrity was paramount. But he laments, ” humility was not an important virtue.”

As physicians we want to appear infallible but in reality we are human and to err is human I have made mistakes in caring for patients and at times have struggled with the dilemma of whether or not to reveal the truth. I hope that some day it will not be a struggle.

Terry Pfau DO, HMD

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