Should Doctors Lie?

It was ironic to read the commentary by Philadelphia surgeon Lester J. Karafin {Second Opinion, Aug. 28} trying to justify doctors' withholding information from patients in the same issue in which columnist Victor Cohn {The Patient's Advocate} pointed out the numerous studies finding that doctors often engage in unnecessary or inappropriate treatment. As long as there is such widespread disagreement among physicians about what treatment a patient should receive, it is hard to see how anyone can seriously propose that it is better for patients not to know.

Dr. Karafin raises the old bugaboo about "terrified consent" and patients who make irrational decisions after allegedly being overly informed. Certainly the doctor-patient interaction must be conducted with tact and sensitivity. But doctors show a profound disrespect for patients when they imagine that pertinent facts must be withheld in order to steer the patient toward the "correct" decision. To quote the play title, "Whose Life Is It, Anyway?" Patrick A. Malone Stein, Mitchell & Mezines Bethesda

What a breath of fresh perspective! Dr. Karafin's article on whether doctors should lie to patients proves there is still a doctor somewhere who is most concerned for his patients, not himself.

When my physician recently informed me that surgery was needed to relieve a chronic problem, she proceeded with a litany of adverse outcomes from the procedure. Undaunted, I asked if the operation could really, notwithstanding the long recuperation period, provide relief. Her reply: "No guarantees, but of course your mental outlook would help."

Of course it would, but how am I supposed to muster the proper positive frame of mind when given such doom and gloom prospects? I will go ahead with the surgery, but only after I find a surgeon I feel won't play so heavily on negative details that it hinders his or her performance or my ability to talk myself into an uneventful, speedy recovery.

Too bad Dr. Karafin doesn't practice in this area. Perhaps he could refer us to some colleagues here who share his common-sense approach to doctoring. Kim McComas Laurel

As an ordinary person who is interested in advances in the medical field and in pursuing knowledge for its own sake, I take umbrage with Dr. Karafin's assessment that the adage "the more a patient knows, the better" is "simply not true." His presumption that a physician has not only a right but a responsibility to withhold information is an abrogation of the trust that I assume his patients place in his judgment.

His complaint that today's patients are often misguided by a barrage of medical "facts" relayed via the media is easily remedied by physicians who take the time to explain misperceptions.

I agree that it is part of a physician's obligation to make judgments. However, we -- the patients -- must not be denied the same information that was relied upon in forming that decision and the opportunity to make a judgment of our own. Withholding this information because the physician is unsure of its possible impact on the patient will indeed return the physician to the "almost godlike figure whose word was taken as gospel" that Dr. Karafin wisely denounces. Janet L. Price Olney

If there exists a good rapport between doctor and patient and the doctor doesn't assume the patient is an airhead, most issues can be resolved. In life-or-death matters, it takes a good deal of genuineness on the part of both persons to cope. Dr. Karafin does not reveal himself as being capable of dealing with people on the level I would want from my doctor. I guess we should be grateful he's in Pennsylvania. We have more than our share of physicians with his approach to patients. Alice K. Helm Attorney at law Bethesda

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