This discussion is colored with subjectivity, and it is largely within the hearts and minds of the doctors—in the privacy of their thoughts—that the true intent of a course of action is known. I once made a judgment error in caring for a patient that led to an unfortunate consequence. My self-revelatory misgivings did not concern the possible error in judgment (most physicians are guilty of this at one time or another), but were more about the motives and personal failing that may have led to that error. I asked myself then, and I continue years later to question, whether my motives were based on beneficence, rather than stubbornness and/or professional immaturity. I’ll never know the truth, but the question haunts me. On the other hand, if I were certain that my motives had been unselfish and beneficent, I would have long ago cast away my concerns. Such demons are one of the many things that separate us from the lay public; our responsibilities are profound!
Explore this issue:February 2017
I want to underscore the importance of truth, trust, and absolute integrity in the physician/patient interaction. Said another way, the most basic and important calculus in this interaction is the patient’s ability to trust their doctor’s unselfishness in giving only advice that is in the best interest of the patient; that is to say, it is based on a premise of beneficence, as opposed to scientific or personal convenience or curiosity. The important question to ask one’s physician, therefore, is “What would be recommended if this was a member of your immediate family?” Once that question is answered with certainty, the decisions in cancer management, for instance—radiation versus surgery or both, chemotherapy or no therapy, the prolongation of life versus acceptance of death, and so on—are far easier to make.
Responsibility to Patients
Over many years of dealing with patients, I have come to believe that physicians don’t realize how powerful their influence really is. Frightened patients are especially vulnerable, and when a trusted physician pushes, real power is in play. Essentially, enormous responsibility is bestowed on the physician by the patient.
When I noted that the true intent was within the heart and mind of the physician, it was this responsibility I was referring to, and for the patient to buy into this transference is the sine qua non of trust. At a minimum, the betrayal of such trust by a physician is a grave moral breach.