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Duty of candour

Is your doctor always open and honest with you?

Doctors have an ethical duty to maintain openness and honesty in all their interactions with patients. This is especially so when a medical error occurs. In medico-legal terms, honesty is referred to as ‘duty of candour’, and is considered as a cornerstone of medical practice. But duty of candour hasn’t always been enforced by law. However, in some jurisdictions, duty of candour has become a legal requirement both for health institutions and the healthcare professionals providing the service.

Medical honesty must always start with the initial doctor-patient interactions. Once your evaluation is complete, the doctor must detail the appropriate treatment options. The option of doing nothing, if applicable, must always be offered. Complex and more expensive options should always be offered last. You must understand everything and give consent. Should something go wrong during the course of your treatment, full disclosure from the doctors and the institution is a must.

Enquiries elsewhere assessing medical disclosure habits among doctors have identified failures in disclosing errors to patients in up to 70 – 97% of cases. But why would doctors have such high levels of dishonesty? Some may assume the specific medical error wasn’t really harmful to the patient. Others may just be paternalistic and assume that they shouldn’t burden patients with yet more difficult medical information. Still some doctors may have psychological difficulties in admitting errors to patients. Fear of litigation is another reason for medical dishonesty, applying to both the medical professionals and their affiliated institutions in equal measure.

The obligation to maintain candour must always apply when the threshold of harm to you as a patient has been surpassed. You must be informed of the incident the soonest possible. The explanation must include details of what happened, immediate or longterm implications, and the remedial measures that must be taken. An apology should be offered as appropriate. You should also get a written report of the events if you like, and offered appropriate support to help cope with the consequences.

But how do you judge if your medical care providers have been completely honest with you? This can be quite difficult, but you will always find tell-tale signs when something is being hidden. It may be your outcome is different from what was expected. Or there is a sudden reluctance to provide you with additional information. Always insist on detailed discussions with your doctors. Asking to keep copies of your records and all the results of your medical tests gives you additional confidence. If you suspect some information is being withheld, just say so.

A doctor’s duty of candour is paramount in modern medical practice. If you ever draw a blank while seeking out your medical information, ask to speak to a more senior person, or the health facility’s management team. Or invoke your inalienable regal right and engage an attorney.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist.

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