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Perhaps least surprising is that doctors give overly positive prognoses. It's hard to deliver bad news, especially when a patient has run out of options, and until recently doctors have had little training in how to do so. But Iezzoni said patients with the worst outlook especially deserve to know, so they can get their affairs in order, and patient studies have found most want to know.
What else might doctors not tell? There are shades of gray, said Caplan, the ethicist. For example, he's heard doctors agonize over what to tell parents about a very premature baby's chances, knowing the odds are really bad but also knowing they've seen miracles.
Doctors prescribe placebos sometimes, and telling the patient could negate chances of the fake treatment helping, he noted. Sometimes they exaggerate a health finding to shock the patient into shaping up.
And sometimes it's a matter of dribbling out a hard truth to give patients a chance to adjust, Caplan said: "OK, this looks serious but we're going to order some more tests," when the doctor already knows just how grim things are.
Withholding the full story is getting harder, though, Iezzoni said. Not only do more patients Google their conditions so they know what to ask, but some doctors who have embraced electronic medical records allow patients to log in and check their own test results.
Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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