Trust as a four letter word

Friday, August 24, 2007

According to the Bus himself, Jerome Bettis time shifted a knee injury to training camp to prevent his coach cutting from him. It seems Mr. Bettis feared he would lose his running back job and faked an injury so that his team, the Pittsburgh Steelers, would not be able to cut him without arranging an injury settlement. In his book, he wrote: “I effectively negated any funny business they were trying to pull on me.”

I have yet to read any significant reaction to Bettis’ actions, but they cause me great concern. Mr. Bettis not only would have to fool the coaches, he would have to fool the doctors, trainer and therapists who cared for him. The funny business is all his.

The physician-patient relationship is based upon trust, but the relationship is usually one sided. The physician has the knowledge and potentially the power to offer treatment, and while informed consent is a great idea in theory, the patient needs to trust the information and options given before accepting the medical advice.

The ideal physician will spend significant time educating the patient about an illness or injury, how it affects the body, what treatments are available, what the side effects are, what are the expected outcomes and also what might happen if no treatment was provided. As well, there might be discussion about alternative therapies that the doctor doesn’t recommend initially, but would be alternatives in the future.

This may be the expectation, but time is never the ally of the physician or of the patient. Often, to meet the wants and needs of their patients, the doctor’s schedule gets too full. (but who wouldn’t want their doctor to fit them if an illness unexpectedly popped up). And patients are unhappy if they have to sit and wait for a doctor running late, though they may have been the cause for other to wait in the past. They want their medical care to be short and sweet. So the patients choose doctors that they can trust and accept diagnosis and treatment decisions with less than ideal discussions.

But what of the trust issue in the other direction. The doctor trusts that the patient is telling the truth, the whole truth and nothing but the truth. If a patient says that he is injured at work, who is the doctor to dispute the fact? If the patient says that he always takes his high blood pressure medication, shouldn’t the doctor believe him, even if the blood pressure readings in the office are too high and the result is another medication prescribed. What future harms will befall the patient who wasn’t completely truthful.

Jerome Bettis chose to cheat his employer and lie to his medical team. What harm could possibly befall him? Please allow me a little fiction:

A patient decides he doesn’t want to go to work and feigns a knee injury. He provides a history compatible with a cartilage tear; popping, giving way, intermittent swelling, difficulty walking up stairs. The doctor takes the history and notes there is tenderness along the knee joint line, a very subjective finding. Initial treatment includes a knee immobilizer, rest, ice and ibuprofen.

The patient takes a couple of days at home in bed watching television and notices his leg starting to swell (the symptom of a potential blood clot). He ignores the swelling, goes to sleep and in the middle of the night, the clot breaks free, travels to his lung (a pulmonary embolus) and kills him.

Purely fictional, but there are consequences to even minor injuries and treatments.

Trust is a special bond that links people. When that trust is suspect, bad things can happen. Physicians and patients are human. A failed relationship because of trust issues will make it harder for each party to share that same amount of trust in their next relationship. Patients will find it tougher to trust another doctor and a doctor, once burned by a patient’s dishonesty, may find it easier to be wary than trusting.

If professional athletes are to be role models, then Mr. Bettis failed. Perhaps it would have been better for him to keep his indiscretions secret, rather than sharing them with the world to sell a few more books.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.