156 Becoming a Patient
twice a day( 9). Some ethicists condone falsehoods that protect another individual.
But when, if ever, is it permissible for physicians, sworn to uphold the Hippocratic Oath, to fib? Pascal, the internist, decided to lie about his HIV diagnosis during a physical exam for residency.‘‘ I had to say‘ No,’ or‘ I don’ t know,’ when I was asked during my physical for my residency. I lied about it.’’ He felt that in this particular setting, the truth was neither necessary nor relevant, and that the risks of truth-telling outweighed the benefits.
Particular revealing events, such as hospitalizations, may prompt deceit. Some anticipated that they would have to dissemble about their diagnosis in the future( e. g., if ever needing to be an in-patient).
Many felt that malpractice and health insurance companies compelled them to be dishonest. Consequently, they didn’ t answer truthfully on applications for staff membership or privileges or malpractice questionnaires. Steven, the suburban endocrinologist, confessed:
It comes up on applications:‘‘ Do you have any problems? Anything that could interfere with you practicing medicine?’’ If you really wanted to be very truthful, you might answer: yes. But who’ s going to?
Yet those who deceived then feared that such lies might later be unearthed. Dishonesty and attempts to protect confidentiality can backfire. Mathilde feared her office staff would learn of her husband’ s illness because of efforts at concealment.
My office manager saw the test. I had put on it the name of a patient, Larry. But Larry didn’ t pay the bill. So my manager called Larry, who in the meantime had died, and said to the wife,‘‘ Why haven’ t you paid the bill?’’ She said,‘‘ We never had the test.’’ I thought my manager might figure something out. She might even have known.
The office manager never spoke to Mathilde further about it, either knowing and respecting Mathilde’ s confidentiality, or remaining unaware.
Not surprisingly, such falsehoods caused enormous psychic burdens. Friends and colleagues may sense they are not being told a full or accurate story, but refrain from questioning apparent half-truths. As Mathilde continued, her friends implicitly agreed to let her falsity remain undisturbed.