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A Piece of My Mind
September 20, 2006


Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2006;296(11):1327-1328. doi:10.1001/jama.296.11.1327

I once found myself in a room full of medical students who were busy justifying a lie. It was a hypothetical lie, not a real one, but it alarmed me nevertheless. These 30 students were discussing an imaginary patient: a young man whose physician had given him the wrong injection to treat syphilis. The students were trying to decide what this patient's physician should do. Having determined (with my help) that this particular mistake was unlikely to harm the patient, the students decided that the physician should simply order the correct treatment without revealing his initial error. Standing at the edge of the group with his hand on his hip, a third-year student suggested a plausible (but false) justification for the extra injections required to correct this mistake. Full disclosure would benefit neither physician nor patient, the group believed. In fact, honesty would imperil the patient's trust in his physician. The students reached this conclusion smoothly, in just a few minutes, with no discernible dissent. The room was quiet, the mood calm. I searched the students' faces with growing dismay, looking for the one or two anxious expressions that might help me shatter the apparent consensus. I did not want the “right” answer to come from me. I wanted the group to find its own way of dealing with the hypothetical mistake I had presented them—but certainly not the deceptive course so easily chosen.