Honesty Is The Best Prescription

Honesty is the best policy, which is a popular proverb, suggests that honesty is not only a moral imperative but also a realistic choice. Honesty is a core value encompassing truthfulness, integrity and fairness and is taught both at home and in school. Honesty is the foundation of trust, which is crucial for any successful relationship, whether personal or professional. Being honest with ourselves and others leads to a clear conscience and enhances personal well-being and health. Along with beneficence and non-maleficence, honesty is a medical ethical principle. Honesty is fundamental to the doctor-patient relationship and a doctor is expected to always tell the truth to his patients simply because it is the right thing to do. 

A good doctor is expected to be intelligent and wise so that he can practice safely and ethically. Presently the medical curriculum is comprehensive yet succinct and getting into a medical college is tough. However naturally talented entrants may fail to reach their full potential at the end of their medical training while less gifted students end up achieving amazing feats. This is due to passion and perseverance in the latter. A lay man would consider a doctor as fit to treat him based on the doctor holding a license and a degree (MBBS or higher). However, there is a wide variation in clinical judgement among doctors ranging from worst to best. Qualities expected in a good doctor include but are not limited to - Knowledge (adequate and continuous), Ethics (unwavering), Professionalism (consistent) and Humility (virtue). These qualities are not quantifiable but noticeable.

A doctor should be a good communicator as patients appreciate 5C’s – Clear, Concise, Correct and Complete information delivered with Courtesy by their treating physician. A patient may disagree with the offered diagnosis, but he then has the freedom to seek a second opinion. A doctor should be courageous to treat an infected patient, raise concern about unethical practice or an incompetent colleague and make an angry patient or guardian calm down with a polite conversation. Doctors must put patients’ needs ahead of their personal and religious beliefs but never withhold information from a competent patient. Doing so is unethical and violation of the Doctor’s role as a fiduciary causing more harm than good in the long run.Unlike incompetency, which can be corrected through training, dishonesty among doctors is a challenging problem as it points to character flaws that are difficult to remediate.

Very often doctors are not able to diagnose a disease but hesitate to inform the patients about this. A doctor may advise the wrong test or fail to advise a necessary test. Other common reasons for inability to diagnose include cognitive biases, mendacious patients, system flaws and the disease itself being rare or difficult to diagnose. As a trainee, I sometimes failed to elicit and document information during patient evaluation that may have a bearing on the diagnosis. However, I was fortunate to have worked under teachers who caught my mistake and encouraged me to accept the same during rounds. Performance focused mindset triggers dishonesty while integrity encourages a doctor to accept and speak the truth.In such a situation the doctor should refer the patient to another specialist or encourage them to seek a second opinion. Errors that can occur during treatment include mistakes in prescribing medications, errors in performing a procedure or failing to perform a necessary procedure.

Sometimes an unwise doctor fails to differentiate between facts and opinions and may confuse his beliefs as modality of treatment and prescribe irrational treatments like oral antibiotic tablets for local application on wounds. Confession is difficult, majorly because of the discomfort of addressing one’s own failing or weakness. This apprehension is more in cases of medical error. Although negligence is a common cause for medical errors, failure to analyze data appropriately is a more frequent reason. It is human to not want to confess an error, especially if the patient got hurt. However, it is my personal belief that patients and their attendants are forgiving if the attending physician admits the truth.

Mahatma Gandhi, the Father of the nation, said “Truth is God”. Doctors aim to alleviate suffering and medical service aligns with the pursuit of truth and hence doctors seek God through service. Many doctors nurture a misconception that the obligation to act with honesty is limited to the clinic. Duty of honesty extends beyond patients to colleagues, family members, relatives and others beyond the clinic.Even in situations where there is no risk of physical harm to anyone, any dishonest conduct undermines the general respectability of the profession.Examples include a display of unrecognized degrees and display of recognized degrees with ambiguitye.g.doctor holding MD Anatomy degree displaying only MD with his name in clinic to give a false impression of being a medicine specialist. The National Medical Commission (NMC) is a statutory body that regulates medical education, doctors, institutes and research and every doctor must follow the regulations of NMC and display their qualifications, experience and current role with honesty. 

Doctors are public figures and should not expect anonymity while using social media. Their opinions carry weight, and doctors should share evidence based medical information, debunk health misconceptions and promote healthy behaviors. Instead of attention-grabbing information, they should share honest and accurate information. Public trust is high, and doctors are considered as credible sources of information. A doctor needs to be an activist and should advocate on behalf of the disenfranchised and vulnerable. Social justice is a public health issue, and many diseases are rooted in the environmental, economic and social policies of the government as also economic inequality. A doctor should offer his honest opinions on contentious issues with supporting evidence and curative measures. He can write a letter to an editor of a newspaper, a public representative or simply post his opinions on a social media platform. However, a doctor’s engagement in activism is credible only if they prioritize and perform their professional duties with honesty.

Dr Dipankara Devebrata is a Guwahati-based ENT specialist and a contributor to articles on Health and Wellness in both English and Assamese languages. He may be contacted at drdipdev@gmail.com.