Appendix 37 - Lying

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

After years studying physicians, ethicist Sissela Bok, in her book Lying: Moral Choice in Public and Private Life, concludes that doctors talk about lying to their patients "in a cavalier, often condescending way...."

Ghost Surgery[407]

In my experience, patients are routinely lied to implicitly or explicitly as to who's actually going to perform the surgery.

An old investigative study conducted in New York state estimated:

1) 50-85% of surgery in teaching hospitals was performed by residents

2) some residents performed surgery without direct supervision

3) most patients were unaware of the degree of resident's participation, and

4) consent forms did not give patients sufficient notice of the degree of residents' involvement.[408]

Not surprisingly, in a study of women who underwent a hysterectomy, ninety-seven percent agreed that the attending gynecologist should tell patients that a resident would participate in the operation. Ninety-three wanted to know specifically what the resident would do. The vast majority also agreed that the attending physician should tell all this to patients a few days before the operation rather than just before surgery.[409]

From a Pharos article entitled "Dilemmas in the Training of Surgeons":

Disappearance of the 'charity' patient as a result of vastly expanded insurance coverage has resulted in the private patient being used in clinical teaching. Understandably, some patients are reluctant to accept the nuisance, aggravation, and discomfort associated with what they consider to be an unnecessary intrusion. Some resent the surgical trainee surrogating the skills and responsibility of the surgeon they chose and justifiably feel cheated or even defrauded by these circumstances.[410]

A surgeon defends this practice in an editorial in JAMA:

[Surgical training was] achieved readily when teaching hospitals maintained a sizable teaching service in which medically indigent patients were largely the responsibility of residents. When Medicare and Medicaid became law in 1965, the question of how residents would be educated without service patients was widely discussed. Since service patients were becoming less numerous, surgery would have to be taught using private patients. Yet surgery cannot be learned by observation; it must be learned by doing. How could this be accomplished in the face of a decreasing number of service patients? How far up the ladder of graded operative responsibility should a surgical trainee be allowed to ascend with private patients?....

As long as the attending surgeon is in the operating room and assures himself [sic] that each task is carried out expertly, he is 'doing' the operation.... It is neither possible or necessary to explain this in detail to every patient.... American surgeons need be neither apologetic nor defensive about our training methods.[411]


[407] Holmes, MK. "Ghost Surgery." Bulletin of the New York Academy of Academic Medicine 56(1980):412-419.

[408] Silverman, DR. "Narrowing the Gap between the Rhetoric and the Reality of Medical Ethics." Academic Medicine 71(1996):227-235.

[409] Kim, HN, E Gates and B Lo. "What Hysterectomy." Academic Medicine 73(1998):339-341.

[410] Roe, BB. "Dilemmas in the Training of Surgeons." The Pharos 1988(Fall):33.

[411] Sade, RM. "Private Patients and Surgical Training." Journal of the American Medical Association 238(1977):2180.

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