Liking your doctor is not evidence you were told the truth
Patients who rated communication with their doctor most favourably were nearly twice as likely to hold a false belief about their own treatment.
This is the most uncomfortable finding available anywhere in this field, and it is why patient-satisfaction scores cannot be used as proof that a conversation was honest.
Researchers surveyed 1,193 patients receiving chemotherapy for newly diagnosed stage 4 lung or colorectal cancer, and checked their answers against full medical records. The chemotherapy in question could not cure them. It was being given to extend life and control symptoms.
69%
Lung cancer patients
Did not report understanding the treatment was not at all likely to cure them
81%
Colorectal cancer patients
Same measure
1.90
Odds ratio
Of holding that false belief, among patients who rated communication most favourably
Patients who rated communication with their physician in the most favourable third were 1.90 times as likely to hold the false belief as those in the least favourable third (95% confidence interval 1.33 to 2.72). Education level, physical function, and how much say the patient had in decisions were not associated with the belief at all.
Two things follow, and only two.
Feeling well informed is not the same as being well informed. And a doctor being liked is not evidence that the doctor was straight with you.
What this study does not showIt does not show that kind communication causes false beliefs. This is an association measured at one point in time. Two readings fit the data equally well: clinicians who soften the message are better liked, or patients who avoid the message rate their clinicians more highly. Either way the warning holds; neither way is a claim about cause.
And these were people with advanced cancer, not pregnant women. The setting does not transfer. The mechanism, comfortable communication sitting happily alongside a false belief, is what transfers.
Say this out loud"Let me say back what I think you told me, and you tell me where I have it wrong."
"What is the most likely bad outcome here, and how likely is it?"
Where this comes from:
456. Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, et al. Patients' expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012;367(17):1616-1625.
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This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.
