Walking the line between candor and cruelty

Physicians should be honest when talking with patients, but must be careful their words are not destructive, experts say.

By Damon Adams, AMNews staff. Aug. 14, 2006.

What is appropriate for a physician to say to a patient in the clinical encounter? When do those comments cross the line of good taste?

Consider these exchanges: A Mississippi physician overhears a surgeon treating an emergency department patient who shot himself in the shoulder in a failed suicide attempt. The surgeon shapes the mentally unstable patient's hand into a gun and tells him to point it in his mouth to get the job done next time.

In New Hampshire, a woman complains to the state medical board that her doctor said she needed to lose weight and was so obese that, if her husband died, she might only be desirable to black men. That report prompted the board to re-examine a previous complaint against the doctor from a woman who claimed he told her to kill herself to end her suffering.

While the first example comes from an alleged incident 20 years ago, the second is the subject of recent litigation. Physician leaders and medical ethicists say the case brings attention to the bedside manner of physicians and how they communicate.

Even if a patient considers the physician to be offensive or bad-mannered, and complains to the state medical board, words alone usually won't lead to discipline, physician leaders said. But doctors need to be concerned about more than just sanctions.

"Patients may have different tolerances for someone who is being candid and someone who is being unkind. Being candid can be a very good thing, but you have to think about the spirit of your candor," said Denise M. Dudzinski, PhD, assistant professor of medical ethics at the University of Washington School of Medicine. "Physicians have a special kind of power and influence with patients."