Leana Wen: What Your Doctor Won’t Disclose (Full Transcript)

“Elected officials have to disclose campaign contributions. Lawyers have to disclose conflicts of interests. Why shouldn’t doctors?”

And finally, many people wrote and said, “Let us patients decide what’s important when we’re choosing a doctor.”

In our initial trial, over 300 doctors have taken the total transparency pledge. What a crazy new idea, right?

But actually, this is not that new of a concept at all. Remember Dr. Sam, my doctor in China, with the goofy jokes and the wild hair?

Well, she was my doctor, but she was also our neighbor who lived in the building across the street. I went to the same school as her daughter.

My parents and I trusted her because we knew who she was and what she stood for, and she had no need to hide from us.

Just one generation ago, this was the norm in the U.S. as well. You knew that your family doctor was the father of two teenage boys, that he quit smoking a few years ago, that he says he’s a regular churchgoer, but you see him twice a year: once at Easter and once when his mother-in-law comes to town.

You knew what he was about, and he had no need to hide from you. But the sickness of fear has taken over, and patients suffer the consequences. I know this firsthand.

My mother fought her cancer for eight years. She was a planner, and she thought a lot about how she wanted to live and how she wanted to die. Not only did she sign advance directives, she wrote a 12-page document about how she had suffered enough, how it was time for her to go.

One day, when I was a resident physician, I got a call to say that she was in the intensive care unit. By the time I got there, she was about to be intubated and put on a breathing machine.

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“But this is not what she wants,” I said, “and we have documents.”

The ICU doctor looked at me in the eye, pointed at my then 16-year-old sister, and said, “Do you remember when you were that age? How would you have liked to grow up without your mother?”

Her oncologist was there too, and said, “This is your mother. Can you really face yourself for the rest of your life if you don’t do everything for her?”

I knew my mother so well. I understood what her directives meant so well, but I was a physician. That was the single hardest decision I ever made, to let her die in peace, and I carry those words of those doctors with me every single day.

We can bridge the disconnect between what doctors do and what patients need. We can get there, because we’ve been there before, and we know that transparency gets us to that trust.

Research has shown us that openness also helps doctors, that having open medical records, being willing to talk about medical errors, will increase patient trust, improve health outcomes, and reduce malpractice.

That openness, that trust, is only going to be more important as we move from the infectious to the behavioral model of disease. Bacteria may not care so much about trust and intimacy, but for people to tackle the hard lifestyle choices, to address issues like smoking cessation, blood-pressure management and diabetes control, well, that requires us to establish trust.

Here’s what other transparent doctors have said.

Brandon Combs, an internist in Denver: “This has brought me closer to my patients. The type of relationship I’ve developed — that’s why I entered medicine.”

Aaron Stupple, an internist in Denver: “I tell my patients that I am totally open with them. I don’t hide anything from them. This is me. Now tell me about you. We’re in this together.”

May Nguyen, a family physician in Houston: “My colleagues are astounded by what I’m doing. They ask me how I could be so brave. I said, I’m not being brave, it’s my job.”

I leave you today with a final thought. Being totally transparent is scary. You feel naked, exposed and vulnerable, but that vulnerability, that humility, it can be an extraordinary benefit to the practice of medicine.

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When doctors are willing to step off our pedestals, take off our white coats, and show our patients who we are and what medicine is all about, that’s when we begin to overcome the sickness of fear. That’s when we establish trust.

That’s when we change the paradigm of medicine from one of secrecy and hiding to one that is fully open and engaged for our patients.

Thank you.

 

Resources for Further Reading:

How Doctors Can Help Low-Income Patients: P.J. Parmar (Transcript)

Why Your Doctor Needs Your Help to Battle Over-Treatment: Christer Mjåset (Transcript)

Lissa Rankin: The #1 Public Health Issue Doctors Aren’t Talking About (Transcript)

How to Build (and Rebuild) Trust: Frances Frei (Full Transcript)

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