Why We Lie

I particularly enjoyed this article from the WSJ last weekend.  It is a piece you finish and satisfactorily conclude your time was not wasted.  You have gained a new perspective in reexamining a deed, in this case lying, that we all engage in periodically—that we rationalize, trivialize, or justify—for unwelcome reasons we sidestep to achieve our selfish ends.  This opening paragraph got me hooked:

Not too long ago, one of my students, named Peter, told me a story that captures rather nicely our society’s misguided efforts to deal with dishonesty. One day, Peter locked himself out of his house. After a spell, the locksmith pulled up in his truck and picked the lock in about a minute.

“I was amazed at how quickly and easily this guy was able to open the door,” Peter said. The locksmith told him that locks are on doors only to keep honest people honest. One percent of people will always be honest and never steal. Another 1% will always be dishonest and always try to pick your lock and steal your television; locks won’t do much to protect you from the hardened thieves, who can get into your house if they really want to. The purpose of locks, the locksmith said, is to protect you from the 98% of mostly honest people who might be tempted to try your door if it had no lock.

The piece deserves a full read, but before I relate this article to physician behavior, which got me thinking in the first place, have a look at the graphic that encapsulates the author’s findings (click to enlarge):

It is not about the money, nor the fear of reprimand, but a host of other factors–surprisingly more potent than financial rewards.  Interesting, huh?

On to the profession of the healing arts…

Another quote came to mind as I read the piece.  It is stinging and harsh.  I have no source, and recall it by memory only because of those latter qualities.  Nevertheless, its context will not require much imagination.  The quote relates to physicians, and the lies they convey to insurance companies to obtain pre-certification for patient testing perceived as necessary:

On Ethics of patient disclosure: any physicians consider lying to a health plan to be a sin on par with the sin of lying to the SS when they knock on the door to ask if you are hiding a family of Jews in the attic.

Ruthless yes, but the comparable root causes that motivate doctors to lie to insurance companies, surface in the article and are stark.  It is a helpful reminder as to why we do it, and perhaps why we should stop.  It is the insight and looking in the mirror thing.

In addition, it is not just insurance companies we deceive, but patients.  Again, we succumb.

The literature is replete with studies like these (search in PubMed–industry COI, error disclosure, etc.), with our elementary features laid bare for all to glimpse.  We are humble folk and have the same foibles as the flock we oversee.

I did take solace in this widely viewed poll though, knowing we have preserved our standing, over time, warts and all:

At least we can console ourselves that we best our elected officials.  As John McCain likes to say on Congress and his colleagues’ plight, “we are down to paid staffers and blood relatives.”

*BONUS*: From the United Hospital Fund: Here.  A nice Q&A explanation for families describing the role of the hospitalist in the care of their relative.