Truth-Telling in Times of Crisis

      In “Truth-Telling, Equity, & Professionalism: Lessons in Leadership from the COVID Frontlines,” James Wright, MD, PhD, MATS, CMD, shared his very personal journey through the COVID-19 pandemic and related how truth-telling was his companion throughout. This partnership was important, he said, because “truth-telling is not only part of our professional code. It is the currency by which we purchase the trust of the community.”

      The Ugly Truth

      When COVID-19 hit one of Dr. Wright’s facilities in Virginia, the truth was not pretty. They had a total of 140 infections and 51 deaths in 6 weeks. “It was the darkest time of my career,” he said. As the situation at his facility gained public attention, Dr. Wright was asked to speak to the media, and he did so honestly. He said, “I wanted the public to know that society had set up facilities that were perfect for a virus like COVID-19.” In an April 14 interview, he was quoted as saying, “A publicly funded nursing home is a virus’s dream. People are close together. Their immune systems are compromised. It is just a tinderbox for that match.”
      After his first interview, the facility’s corporate lawyer expressed concerns about Dr. Wright’s comments. He said, “I agreed we would go back to a PR company producing statements, and I would review and submit them. That lasted for about 30 minutes.” A few months later he was relieved of his medical director duties at that facility.

      Truth and Consequences

      Dr. Wright said, “We recognize the impact of truth-telling.” Honesty comes with consequences. However, despite the risks involved, he stressed, “Truth-telling is not only part of our professional code. It is the foundation of informed consent, and informed consent is the foundation of patient autonomy.” He observed that this is part of our “ongoing contract with society, and they are watching us closely to make sure we are adhering to it.”
      Dr. Wright also observed that truth-telling is the foundation of all advocacy, and he has made the most of this opportunity in recent months. “My goal in truth-telling was partly to advocate for the most disenfranchised population in the country.”
      While truth-telling is a standard of care for physicians, Dr. Wright admitted that it’s not always easy. He said physicians are “relatively powerless” against entities with money, power, and the ability to make or break careers. “There are real threats and real reasons not to tell the truth.” Yet, he stressed, “the power you have to advocate for your patients really comes down to the truth. That really is the only power you have. Don’t forget to use it.”

      What Is Truth?

      The COVID-19 pandemic and experiences like Dr. Wright’s have brought the concept of truth to the forefront. In this era of “post-truth,” Robert Zorowitz, MD, MBA, FACP, AGSF, CMD, regional vice president of health affairs, Northeast Region, Humana, Inc., talked about how the line between truth and misconceptions, opinions, and theories has been blurred during the pandemic. He quoted from a Lancet article: “The tidal wave of information on the internet concerning the COVID-19 pandemic has resulted in difficulties in discerning truth from fiction. This so-called infodemic, defined by [the World Health Organization] as an ‘overabundance of information — some accurate and some not — that makes it harder for people to find trustworthy sources and reliable guidance when needed,’ has become a major threat to public health” (2020;396:291).
      In medicine, Dr. Zorowitz said, “truth is the combination of fact(s) with its relevant caveats and uncertainties.” He admitted that truth-telling in medicine has changed through the years. “We have not always been clear about our duties to tell the truth.” For instance, he cited a 1961 survey of U.S. physicians in which 90% of respondents said they wouldn’t reveal a cancer diagnosis to their patients. This was in contrast to a 1979 survey in which 97% of respondents said they would tell a patient about such a diagnosis.
      These days, Dr. Zorowitz said, “we feel more of an obligation to tell the truth.” He cited the American Medical Association (AMA) Code of Medical Ethics, which states in part, “Truthful and open communication between physician and patient is essential for trust in the relationship and for respect for autonomy. Withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated creates a conflict between the physician’s obligations to promote patient welfare and to respect patient autonomy” (Opinion 2.1.3).

      Challenges of Sharing Truth in the Age of COVID-19

      Sharing truth with patients and families has been challenging in the age of COVID-19, Dr. Zorowitz admitted, particularly since so little was known about the virus in the early days. However, he noted, “As we learn more about the virus, physicians are able to provide better information to patients and their families.” He added, “We acknowledge more and more that patients want the truth about their diagnoses, and they have a practical need for this information.”
      Ultimately, Dr. Zorowitz said, “Truth works,” whether with an individual or a group. “Truth must be delivered objectively and openly, but with empathy and curiosity. Solicit questions — ask what the individual or group is thinking. Transparency should be the default mode ... period.”
      Dr. Zorowitz admitted, “Communicating truth may be uncomfortable, but in the long run, you will be better positioned to maintain trust.” This is an important part of upholding the contract that medical professionals have with society, which is never more important than during a crisis like a pandemic.