The Lies We Tell: Viewing Patient Deception Through a Multidisciplinary and Patient-Centered Lens. Sponsored by the ACLP Bioethics SIG.

Abstract:

Background:

Despite being trained to value honesty, health care providers frequently lie to their patients. Professional codes of ethics generally consider it unprofessional to deceive patients. Yet deception is not explicitly addressed in medical training or even regularly acknowledged. Given this lack of training, physicians may lack a nuanced and practical approach to considering whether or not deception is appropriate in a specific situation. Questions of deception may be nested within other consultations, such as capacity questions, management of neuropsychiatric disorders or severe mental illness, and involuntary treatment.

Approach:

This multidisciplinary and interactive workshop will explore clinical and ethical situations in which patient deception may be an acceptable option from four perspectives: the clinical ethicist, the consultee, the patient, and nursing staff. Each speaker will contribute a lens to provide the psychiatric consultant with a more complete view of the needs of various stakeholders. Throughout the session, participants will be provided with practical tools to approach these challenging situations and the opportunity to practice utilizing these skills through active learning pedagogies. The workshop will begin with participants being polled on how they would respond to different vignettes in which various forms of deception might be employed. We will then review fundamental concepts in clinical ethics consultation, discuss practical decision-making tools for clinicians, explore how patient perspectives can be incorporated, and integrate the view of nursing staff.

Format:

10 minutes- attendees will be polled as to both their own willingness to engage in deception with patients in a variety of clinical contexts that span the spectrum of deception.

15 minutes- Dr. Rudolph will focus on the perspective of a clinical ethics consultant. Using case vignettes and active learning approaches, she will explore the general format of a clinical ethics consultation, how to formulate a clinical ethics question, and the role similarities and distinctions between CL psychiatrists and clinical ethicists.

15 minutes- Dr. Levinsohn will focus on the perspective of the primary team. He will discuss how moral distress and countertransference may have an outsized impact on clinical decision-making in the context of deception. Attendees will be given an opportunity to practice using an algorithmic approach that may serve as a more objective reference (Sokol, 2017).

15 minutes- Dr. Zack will focus on the patient perspective, including the role of psychiatric advance directives. She will discuss the potential benefits and challenges of PADs and review barriers to using PADs in clinical practice.

15 minutes- Ms. McNeil will provide an interdisciplinary perspective on deception in patient care, underscoring how approaching the use of deception in patient care requires integrating perspectives from nursing staff.

5 minutes- participants will be asked to return to the vignettes presented at the beginning of the presentation and asked to practice applying the skills presented throughout the workshop