Ethical dilemma

1. 醫學二 李桎陞 B9802108 Ethical dilemma

2. Introduction • There is an open secret in medicine--- patients lie. • Hippocrates said that patients can't always be trusted when they say they've taken their medicine. • Can doctors trust their patient?

3. What is lying? • Lying is giving some information while believing it to be untrue, intending to deceive by doing so. • A lie has three essential features: • A lie communicates some information • The liar intends to deceive or mislead • The liar believes that what they are 'saying' is not true

4. Have you ever lied to the doctor?

5. What the users say? • WebMD invited readers to respond to an online survey. The nearly 1,500 responders told us whether, when, and why they don't tell their doctors the whole truth. • WebMD users say they are pretty good liars. Only 7% said their doctor had ever caught them in a lie.

6. What do patients lie about? • 6% lied about their personal or family history • 2% didn't tell their doctors about some of their symptoms -- or exaggerated their symptoms • 1% lied about feeling better • 38% lied about following their doctors' orders • 32% lied about their diet or about how much exercise they got • 22% lied about smoking • 1% lied about their pain • 1% lied about abortions or earlier pregnancies • 1% lied about mental health or depression • 17% lied about sex • 16% lied about how much or how often they drink alcohol • 12% lied about recreational drug use • 3% lied about other things • 7% lied about getting a second opinion • 7% lied about taking herbs, supplements, or alternative therapies

7. Why Do We Lie to Our Doctors? • 2% didn't want a lecture • 1% didn't think the lie was important • 1% lied because they disagreed with their doctor • 50% said they didn't want to be judged • 31% said the truth was just too embarrassing • 21% didn't think the doctor would understand • 9% said it was none of their doctor's business • 1% didn't want the truth to appear on the medical records or to be available to their insurance companies • 6% lied to get a particular drug or treatment • 5% gave other reasons for lying • 2% said they would not get medications

8. What the patients feel? • feelings of guilt

9. What are the effects of lies? • Within medicine, physicians are often tempted to retaliate（報復） against patients who lie by withholding treatment • Lies that go unrecognized can promote misinformation or lead to treatment that is inappropriate or harmful.

10. Discussion • How can one detect lies? • How the physicians treated the lies of the patient?

11. How can one detect lies? • speech patterns and facial cues • voice pitch • use of indirect speech and pauses • Altered rate of speech • changes in breathing patterns, sweating, and an increase in swallowing

12. How the physicians treated the lies of the patient? • rehearse different communication strategies • Disclosed the patient

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