Are doctors allowed little white lies?

Are small fabrications OK with veterinary clients if you think you're sparing feelings? (Shutterstock.com)Dr. Lewis was in his 28th year of practice, with a busy clinic, a good reputation and an excellent support staff. Three veterinarians, six technicians and four receptionists served his suburban community with pride and compassion. In the past three months, however, several cases were handled in a manner that challenged the “professionalism” of the staff.

‘I'm sorry, Mrs. White, but Toodles has already taken the train to the Rainbow Bridge … '

Mrs. White presented her beloved Boston terrier, Toodles, to the clinic in end-stage renal failure. She and Dr. Lewis had been managing the disease for almost two years, and now the end had come. The dog wasn't eating, had started vomiting and was displaying neurological symptoms. Mrs. White and her family were with the dog when he was euthanized. Even with a wonderful support system around her Mrs. White's grief was still overwhelming.

Dr. Lewis was concerned with the look of the now-frozen cadaver.

The pet was wrapped and placed in the clinic freezer while awaiting pick up for private cremation. The morning of the pick-up Mrs. White's daughter called and told Dr. Lewis that her mother wanted to see the body. Dr. Lewis explained that she thought this was a bad idea and would further traumatize her elderly mother. In addition, Dr. Lewis was concerned with the look of the now-frozen cadaver. It was agreed that in the interests of the grieving elderly owner, she would be told the body had already been transported and cremated.

‘Who can say what happened? But we'll fix her up, Mrs. Hass.'

Jim Hass presented his mother's 3-year-old Yorkie with pain in the left front leg. Jim lived with his mother and her two dogs. At the home, Jim, a big fellow, had sat down, not knowing Pixie was in his chair, and he heard her cry out. The result was a hairline, non-displaced fracture of the distal ulna. Pixie would be fine and unfortunately accidents happen. But Mr. Hass had a special request: “Doc, could you tell my mom that Pixie slipped and hurt her leg and that she'll be fine?”

Dr. Lewis reported to the elderly Mrs. Hass that her dog had a small fracture and that a splint and time would fix her up good as new. When she asked what had happened, Dr. Lewis told her sometimes it's easier to fix things than to figure out what caused them. Mrs. Hass was both grateful and relieved.

‘I guess Lucky just got unlucky with something he ate, Mrs. Smith'

Our third and final case under consideration started when the Smith family-husband, wife and 16-year-old daughter-came in with Lucky, their 5-year-old retriever. Lucky had started vomiting and became disoriented the previous evening. He seemed bright and alert during his visit, but his owners were concerned. As Dr. Lewis was examining the dog, his receptionist asked him to step out of the exam room. She informed him that the young girl told her that Lucky had gotten into some of her marijuana stash. The teenager asked that her parents not be told.

Dr. Lewis gave the dog a clean bill of health and recommended a bland diet for three to five days. He did speak to the mother and enquired whether the family could discuss back home among themselves anything unusual that the dog ate that could have led to this upset.

‘OK, team, what did we learn?'

These three instances of questionable transparency led to a staff meeting.

Dr. Lewis felt he was obligated to not only assist his pet patients but also to consider the overall family dynamic. He felt that creating needless family strife when pets' medical problems were completely resolved was unnecessary.

Saving the pet is the veterinarian's responsibility, saving the world is not.

Two of his colleagues had a much simpler and direct opinion. They felt a clinician had an ethical responsibility to be honest with the pet owner. The ultimate impact of the truth was not the veterinarian's responsibility. Saving the pet is the veterinarian's responsibility, saving the world is not.

The heated staff meeting resolved very little.

Do you agree with the “honesty is the best policy” doctors, or do you side with Dr. Lewis, who doesn't want to ruffle feathers? Let us know at dvm360@ubm.com.

Rosenberg's response

Part of a veterinary clinician's DNA is empathy. It's clear that Dr. Lewis understood both pets' medical issues as well as clients' anxiety. He did his best to address both. In the midst of his well-intentioned efforts, however, I believe he lost his way. His ethical obligation is to be honest and transparent with the pet owner. Dr. Lewis should have understood that the final part of assisting his pet patient involves honestly reporting to the pet owner.

Responsible adults receive upsetting information every day and manage to deal with it.

Sometimes this information is upsetting. Responsible adults receive upsetting information every day and manage to deal with it. Dr. Lewis' transparent reports ultimately may have contributed to some unintended family chaos. This possibility in no way relieves the veterinarian of his or her ethical responsibility. It is true that many cases we deal with are not clear, black-or-white issues. That being said, little white lies are never an acceptable alternative.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. In his private time, he enjoys playing basketball and swing dancing with his wife. Although many of his scenarios in “The Dilemma” are based on real-life events, the veterinary practices, doctors and employees described are fictional.