Lying to each other - When internal medicine residents use deception with tumor colleagues

Background: While lying is morally problematic, physicians have been known to use deception with their patients and with third parties. Little is know n, however, about the use of deception between physicians. Objectives: To determine the likelihood that resident physicians say they w ould deceive other physicians in various circumstances and to examine how v ariations in circumstances affect the likelihood of using deception. Method: Two versions of a confidential survey using vignettes were randomly distributed to all internal medicine residents at 4 teaching hospitals in 1998. Survey versions differed by introducing slight variations to each vig nette in ways we hypothesized would influence respondents' willingness to d eceive. The likelihood that residents say they would use deception in respo nse to each vignette was compared between versions. Results: Three hundred thirty surveys were distributed (response rate, 67%) . Of those who responded, 36% indicated they were likely to use deception t o avoid exchanging call, 15% would misrepresent a diagnosis in a medical re cord to protect patient privacy, 14% would fabricate a laboratory value to an attending physician, 6% would substitute their own urine in a drug test to protect a colleague, and 5% would lie about checking a patient's stool f or blood to cover up a medical mistake. For some of the scenarios, the like lihood of deceiving was influenced by variations in the vignettes. Conclusions: A substantial percentage of internal medicine residents report they would deceive a colleague in various circumstances, and the likelihoo d of using deception depends on the context. While lying about clinical iss ues is not common, it is troubling when it occurs at any time. Medical educ ators should be aware of circumstances in which residents are likely to dec eive, and discuss ways to eliminate incentives to lie.