The lies we tell

I lied. I lied to my wife.

It’s out in the open now, so I can talk about it. She celebrated a special birthday this year and, because she is the Queen of Surprise Parties, I felt the need to throw her a surprise party in return for all the good surprises she has given me. Planning her party involved secrets, lies, subterfuge, conspiracy, deception, dishonesty, evasion, and misrepresentation. I was hiding my phone so she couldn’t see texts from her friends and family members who were in on the surprise. I made up cover stories to explain my behavior. In the weeks leading up to the surprise I found myself waking up frequently in the night worried that I would inadvertently let the secret out. In the end, the party was a huge success and my wife enjoyed spending an evening surrounded by many of her close friends and family. All was forgiven.

All of this got me thinking about the lies we may tell our patients and about the lies they tell us. Physicians may lie, deceive, and misrepresent, for example, in order to get a patient to comply with treatment. This very paternalistic approach will invariably backfire on the physician. Doctors may also withhold information, for example, to avoid giving the patient bad news. Hopefully, those attitudes are long gone.

Recently, I tried to tell a frail, elderly patient that I believed that her life was nearing its end. She had end-stage chronic disease. As she lay in her hospital bed, becoming weaker and more drowsy, I started to tell her gently what I thought was happening. She politely disagreed with me, as if to say that she didn’t want to know what was to come. I didn’t push it, and she passed away peacefully 2 days later. Hopefully she heard what I was trying to tell her. I don’t like giving patients bad news, but I know that honesty is appreciated more than any attempt to protect them from harm. If we, as physicians, want to continue to be seen by the public as some of the most trusted professionals, then we need to live up to that.

I also remember two patients I fired many years ago over lies they told me. I didn’t like being manipulated and, after discovering their lies, I felt that they had damaged the doctor-patient relationship irreparably. Both patients lied to cover their misuse of opioids. I think that this is a common situation in which patients lie to doctors. Both patients’ lies put them, me, and the public at risk, and I did not feel comfortable in continuing as their doctor. On that topic, all I will say is that there is a right way and a wrong way to fire a patient. As I found out more recently, if you don’t do it correctly you may receive a pale yellow envelope in the mail containing an unpleasant letter of complaint and, ultimately, reprimand.

What I learned from the recent subterfuge surrounding my wife’s birthday celebration is that lying is tiring. It took work to build the lies and keep them from being discovered. It disrupted my normal sleep pattern and made me worry about being found out. Except for the obvious case of a surprise birthday party for a loved one, I don’t think it is worth all that energy.
—DBC