Survey Shows That At Least Some Physicians Are Not Always Open Or Honest With Patients

Iezzoni, Lisa I.; Rao, Sowmya R.; DesRoches, Catherine M.; Vogeli, Christine; Campbell, Eric G.

doi:10.1377/hlthaff.2010.1137

Cited by 80 publications

(55 citation statements)

References 39 publications

(45 reference statements)

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“…[18][19][20] Physicians values differ-in particular, their definition of professionalism and how they balance professional values and the time and resources available to meet these internal expectations. 21,22 This can be manifested in efforts to seek out current clinical evidence, attitudes towards clinical autonomy, and-harking back to the principal-agent problem-how patient and personal considerations are balanced. 13 Some clinicians, for instance, view the patient's ability to pay as valid considerations in treatment decisions, while others don't.…”

Section: 1516mentioning

confidence: 99%

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

2015

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There is ample evidence that many clinical decisions made by physicians are inconsistent with current and generally accepted evidence. This leads to the underuse of some efficacious diagnostic, preventive or therapeutic services, and the overuse of others of marginal or no value to the patient. Evolving new payment and delivery models place greater emphasis on the provision of evidence-based services at the point of care. However, changing physician clinical behaviors is likely to be difficult and slow. Policy makers therefore need to design interventions that are most effective in promoting greater evidence-based care. To help identify modifiable factors that can influence clinical decisions at the point of care, we present a conceptual model and literature review of physician decision making. We describe the multitude of factors-drawn from different disciplines-that have been shown to influence physician point-of-care decisions. We present a conceptual framework for organizing these factors, dividing them into patient, physician, practice site, physician organization, network, market, and public policy influences. In doing so, we review some of the literature that speak to these factors. We then identify areas where additional research is especially needed, and discuss the challenges and opportunities for health services and policy researchers to gain a better understanding of these factors, particularly those that are potentially modifiable by policymakers and organizational leaders. 5 Many studies have observed large variations in clinical practice, across geographic areas and within local areas or even specific physician organizations. 6 We are undergoing rapid change in healthcare organization and delivery. Physicians are increasingly practicing in larger organizations and systems of care, in part prompted by widespread initiatives by federal, state, and private payers to improve care quality and lower costs. These reform efforts, such as patient-centered medical homes and accountable care organizations, along with significant federal funding of comparative effectiveness research, incentives for adoption of health information technology that includes decision support, and feedback on clinical quality performance raise the hope and expectation that clinical decision making will improve, with greater adherence to accepted evidence.Within this context, research and requisite data collection on key factors affecting physician decision making is necessary to design interventions and refine current ones. In this article, we present a conceptual framework for understanding factors contributing to physician clinical decision making, specifically those related to physicians' use of evidence at the point of care. With this framework, we conclude with directions for future research and the data needs necessary to conduct this research.We frame our discussion in the context of physician decision making as part of a broader inquiry into collecting data on physicians and their practice organizations. Of course, evidence...

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Section: 1516mentioning

confidence: 99%

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

2015

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“…Researchers reported some patients might not receive comprehensive and precise facts from their physicians, and uncertainties about whether patient-centered care is largely possible without more extensive physician commendation of the core communication principles of openness and honesty with patients (Lezzoni et al, 2012). Henceforth the Charter on Medical Professionalism, recommended by more than 100 professional groups internationally and the US Accreditation Council for Graduate Medical Education, necessitates frankness and trustworthiness in physicians' communication with patients (Lezzoni et al, 2012). The progressive interference of market force into the dominion of medicine is frightening to switch the principles of professionalism with the conflicting ethics of the marketplace.…”

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confidence: 99%

Professionalism of future medical professionals in Universiti Sultan Zainal Abidin, Malaysia

Salam

Yousuf

Islam

et al. 2013

Bangladesh J Pharmacol

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“…4 Last year a study was published in Health Affairs that showed 1 in 10 doctors admitted to knowingly lying to a patient, and more than half "described a patient' s prognosis in a manner more positive than warranted." 5 Other doctors will admit to lying to demented patients for their own good, and recommend discreet silence as a healing art at times when a barrage of cold, hard truths might do harm. 6 Optimistic lies about the prognosis of a sick and possibly dying child, we might reasonably suppose, are likely to be more common than those told to adults or the elderly.…”

Section: Deception and Self-deception Introducedmentioning

confidence: 99%

Deception and the Death of Ilyusha: Truth and the Best Interest of a Dying Child in The Brothers Karamazov

Martin¹

2014

Pediatrics

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For centuries, many physicians and parents assumed that it was ethically justifiable to lie to a dying child. The reasoning was clear. Because the lie would likely eliminate or prevent a concrete harm (the child’s fear), and the lie is about a harm that is unavoidable anyway, a lie appeared to be the morally desirable thing to do. Today, the ethical consensus has shifted. Many doctors and other health professionals now argue that we have an obligation to tell children the cold, hard truth. In this article, I argue that “the cold, hard truth” (assuming we can know it with certainty) might not always be in the best interest of the patient. To illustrate the point, I analyze an episode in Dostoevsky’s novel, The Brothers Karamazov, in which a child is dying, his father lies to him about it, and 2 doctors take very different approaches to the truth. Each of these individuals has a particular interest when it comes to the question of “the truth” about the death of Ilyusha. I use this story to ask whether it is ethically permissible to lie to a dying child and, if so, who has the moral authority to tell that lie.

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Survey Shows That At Least Some Physicians Are Not Always Open Or Honest With Patients

Cited by 80 publications

References 39 publications

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

Factors Contributing to Variations in Physicians’ Use of Evidence at The Point of Care: A Conceptual Model

Professionalism of future medical professionals in Universiti Sultan Zainal Abidin, Malaysia

Deception and the Death of Ilyusha: Truth and the Best Interest of a Dying Child in The Brothers Karamazov

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