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 DISHONESTY IN MEDICINE

It's an uncomfortable reality. Ironically, dishonesty demands us to honestly admit it occurs so that it can be addressed. Failing to admit it causes harm to our patients, our training and our careers. The high level of competition to get the medical school, residency, or job we want, combined with the fear of embarrassment if we fail and the risk of being humiliated by our superiors if called out on our mistakes, all can lead us down the slippery slope into dishonesty.

Examples of dishonesty in medical training include: cheating on a medical school exam; exaggerating on our resumes; omitting less than glowing things in our past performance; documenting something as done in a patient evaluation which we actually forgot to do; saying 'no' when asked about the presence of something in a patient's history when we actually failed to ask; covering up an error in rounds; plagiarizing sections from prior patient evals into your current eval; taking credit for a peer's work; denying that we made a mistake; blaming others or your program for your mistake or performance difficulty;  calling in sick when not ill; not reporting adverse events and unsafe conditions; and, claiming that you never got the page or email when you actually forgot to reply.

You may be reading this topic page because others have expressed a concern about your honesty in some aspect of your performance. How you handle this will be critical to how others view you and whether they will want to work with, supervise or recommend you. Here are our recommendations for how to handle this in your most professional manner possible.

1. First, pause. Being told you've been dishonest will cause an intense emotional reaction. Don't try to respond in the midst of that emotion. So pause. Take a few deep breaths. See the RWBC Emotion Shift topic page for ideas

2. After pausing to regain composure, you might say, "I understand you don't think I was honest about………..I will go take care of the problem and then later can we talk about this?"

3. Then engage a reflection process. Think about the situation. Be honest with yourself. What part of the other person's belief that you were dishonest is accurate? Consider your motives behind your dishonesty. These aren't excuses for your dishonesty. They are tools to help you understand what influenced your decision to be dishonest. Once you clarify that, you can change it. A common motivation for dishonesty stems from a fixed or performance-focused mindset. Here is a short You Tube video introduction to the concept of growth and fixed mindsets.

Next, read this short article on fixed and growth mindsets and their impact on managing mistakes in training.

Finally, here is a self-assessment to do for your mindset:

4. Then, talk with someone. Someone you trust who will listen, support and be honest with you. If the issue is not one with a patient safety concern, you can consult with RWBC and the full confidentiality for any resident consult with RWBC will be adhered to. Here's the link for what to expect in a consult.

5. Then consider making a Repair. A Repair is a 3 part response a person makes when they have made a mistake. In this order, a person:

a.  Admits what they did that was a mistake.

b.  Apologizes for what they did that was a mistake.

c.  Acts to amend what they did and/or states an intention and plan to learn from the mistake and preclude its recurrence. This is where the growth mindset is crucial.

How you manage dishonesty now will set the stage for how you manage it for the rest of your career. Please consider the guidance above. We are here to support your success in all aspects of your training, including this. Consult with us at any time.

Resources:

1. Managing your PIP RWBC topic page

2. A Growth mindset approach to preparing trainees for medical error

3. Dishonesty in Medicine Revisited article