Can patients really handle the truth?

Atlanta A man in his 60s comes into the emergency department with abdominal pain. When doctors try to locate the problem, they discover a uterus and two ovaries.

Earlier strokes have made the man incompetent. Should doctors -- in this true story -- tell the man's wife and two children, who believe the man is their father, that he is a masculinized woman? Or do physicians withhold the information because they believe it could cause more harm than good?

Recent medical literature has said patients want to know the truth and that they handle it well, even when it is difficult, so the AMA Council on Ethical and Judicial Affairs invited physicians to comment on when -- if ever -- it might be appropriate for doctors to withhold information.

The complex question was the focus for comments at the CEJA Open Forum held at the American Medical Association's Interim Meeting in December.

Most physicians who spoke said patients have a right to know any and all information and be given the facts they need to make informed decisions.

"Patients are not always given a broad base of information to help them make a decision," said Maryland psychiatrist Robert M. Phillips, MD, a delegate from the American Academy of Psychiatry and the Law. "We must inform patients of our knowledge and direct them to people with other experiences and opinions on treatments."

Michael A. Williams, MD, a Maryland neurologist and delegate from the American Academy of Neurology said that physicians have an obligation to talk to colleagues about the best way to tell a patient about a diagnosis if they themselves do not have all of the skills required to deal with the numerous issues that might be raised.

"The question isn't to tell or not to tell the truth, but how and when to tell the truth," Dr. Williams said. "[Physicians need] to divulge it in a way that is respectful and helpful to the patient. We assume [the information] could be damaging, but maybe it's not. Maybe it answers questions they've always had."