I spent a delightful New Years Eve with close friends. All the adults at the party were medical professionals or lawyers and we ended up discussing a thorny medico-legal issue. What should a doctor do when he discovers another doctor’s mistake?
Everyone agreed that when a patient asks a doctor directly (“Did my internist miss my cancer?”), a doctor is legally required to tell the truth. The more difficult question is what to do when a patient doesn’t ask. In that case, there is no medico-legal requirement to point out another doctor’s mistake to a patient, but is there an ethical requirement?
The discussion eventually focused on “what a patient would want to know.” I suggested (okay, I argued) that a patient would want to know the same things that any doctor would want to know in a similar situation. I was surprised by the amount of resistance from the other medical professionals. They insisted, often quite passionately, that telling a patient about a mistake that cannot be fixed will upset her unnecessarily, erode trust in a doctor the patient may be still relying upon, and provide absolutely no benefit.
I still believe that honesty is the best policy. Yet I cannot stop thinking about the passionate defense that others mounted, that a doctor should be committed to a patient’s well being, and that full disclosure might have more harms than benefits. We bandied about the phrase “what a patient would want to know” quite a bit, and it occurred to me that I could ask the question of lots of people by posting it here.
Here’s the scenario that we discussed, a case that actually happened:
A woman was referred to an oncologist for treatment of lung cancer. As is often the case, by the time the patient had symptoms, the disease was quite advanced and the prognosis was poor. The patient had other, unrelated medical issues, and therefore came with a very thick medical chart. Before meeting the patient, the oncologist carefully reviewed her past medical history. After looking through the plethora of previous X-rays and CAT scans, the oncologist made a unfortunate discovery that the lung cancer had been seen on a chest X-ray more than a year before the diagnosis, when it was still quite small and easily treatable. Her personal doctor had simply missed it, a mistake that could not be justified.
After meeting with her, the oncologist concluded that the patient believed her lung cancer was just bad luck. It had not occurred to her that it could have been diagnosed even before she had symptoms. The oncologist pondered what to do. There was no medical benefit to informing the patient: nothing could be done to fix it, and now that she had been referred to an oncologist, her primary doctor would no longer be caring for her. Telling the patient about the mistake would almost certainly cause her additional anguish, which she did not need as she embarked on an arduous course of treatment for her advanced cancer.
Given the circumstances, if you were that patient, would you want to know that your doctor had made a mistake?