Honesty is the best policy

A policy is defined by Merriam Webster’s dictionary, as, among others, “prudence or wisdom in the management of affairs” or “a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions.” There are some policies germane to one’s life and others, our professions in the life sciences.

Obviously, there are the policies to cover life, car, house, health insurance and other similar issues. As a pilot, I also have a policy that addresses my adventures in aviation.

Most people are fully aware that insuring a house for fire and then committing arson is not only illegal but will invariably lead to a lengthy spell inside an establishment with very few “likes” on social media.

Lying on a life insurance application has the potential for a sorry state of affairs when a medical report or post-mortem demonstrates manifest dishonesty.

But what of other policies? I offer up several that have one thing in common; honesty.

If you have children you may have read to them at some point a wonderful book by Stan and Jan Berenstain entitled “The Berenstain Bears tell the truth” in which we see how one untruth leads inevitably to a web of deceit. The message to the young cubs, and any children hearing the story, is that dishonesty erodes trust in others and renders life’s journey more turbulent than it needs to be. The analogies for those of us in the life sciences are obvious and yet, equally sadly, we see evidence every day of people blurring the edges around the truth. It is a reasonable mechanism to ask children “is this the truth as it is, or the truth as you want it to be?” Sometimes the truth is inconvenient; better that than a fib that leads to potentially dire consequences.

Lying to one’s doctor about symptoms, or failing to attend at all is not a good idea but is sadly not uncommon and people do it all the time. That irritating chest pain that must be heartburn, may be something more sinister. Yet the cemeteries are full of people whose loved ones will tell you that the pain had been going on for months before that fateful day. Railing against reality will not make it go away and as bad as lying to one’s doctor, lying to oneself is infinitely worse and far more common. I recall the patient who came to my hospital with profound gastrointestinal bleeding and required extensive resuscitation. He had failed to tell anyone that he had hemophilia and that diagnosis became difficult to establish during massive transfusions. The reason? He was ashamed of his problem and thought that it would compromise the way he was cared for. In truth, failing to disclose this vital element of his history might have cost him his life but certainly cost the hospital a whole lot more money to treat him than it would have had he told the truth.

As a pilot, failing to attend to a known medical problem or not reporting it to the authorities is a breach of regulations and is neither productive nor sane. Failure to report such things is a dereliction of duty and potentially risks the lives of passengers and others at risk. Even a small number of such cases impacts all of us, causing those opposed to private aviation to take issue with our right to fly.

But untruths in healthcare can have profound consequences for many people. For instance, when running a clinical trial, potential subjects are asked about pre-existing medical conditions. Failing to disclose something might lead to an avoidable adverse event that could derail an entire program and prevent, or delay a drug or device making it to market and at the very least, can cost the sponsor a great deal of money.

Working in the medical field surely implies that one should have a sure moral compass and yet we do see occasions where companies purposefully mislead or deceive. This is unconscionable and it seems that steep fines from regulators do not deter those with such intent.

Yes, one needs many policies in life, but honesty is the best one.