The vast majority of people who become physicians are truly invested in helping their patients and achieving the best outcomes for them. For several decades, there has been an increasingly antagonistic approach toward how we manage mistakes in medicine. This trend has been brought on by a mistrust on the part of patients as their medical and insurance costs skyrocket and their access to care is more limited. It is further fueled by physicians’ lack of time to spend just talking with patients, as patient panels are being ever expanded and demands on physicians continually increase.

It is also brought on by a physician’s uncertainty about what to do when a mistake has been made. Hosptial administrators and attorneys had, for a long time, told doctors to refrain from telling patients and their families about errors because medical costs and malpractice awards have increased, and rampant litigation continues. The rationale was that withholding this information would curb malpractice liablity. This left the doctor in the middle. On the one hand, the physician wants to help the patient and be truthful, but on the other hand, there is a fear of lawsuits, which demonstrates a mistrust on the part of the physician toward the patient.

How did we get to this place? Physicians still remain, by and large, trustworthy and true advocates for the patient. Patients, although not to the same extent as in the past, still hold physicians in high regard and want to trust and believe in what they say. It is vitally important, in my opinion, that emergency physicians continue to trend toward truth telling. If we do not, this balance of trust may be forever lost, and trust is the foundation of the physician-patient relationship.

Fortunately, the pendulum is swinging back toward transparency and disclosure. There are several ways that this being accomplished. First, many institutions are adopting a truth-telling policy. This has been fueled in part by a large study of a VA hospital that has been ongoing for more than a decade. That study clearly demonstates that, at least for that patient population, patients are less likely to sue, even where there was negligence, as long as the physician told them of the mistake and told the truth.

Second, laws are being passed that allow a doctor to tell the truth at the time of the mistake, yet bar those statements from admission at trial.