What Is the Cost of Truth?

All our lives we have been instructed to tell the truth. I am sure that as a child you may have been disciplined if you did not tell the truth. When it comes to telling the truth today, do we really do it? And more importantly, do we really want to hear it?   Everyone is aware of the story of the wife who asks her husband, “Does this outfit make me look fat?” In situations like this, we may profess to want the truth, but we seldom mean it! This is humorously pointed out in a poem by Judity Viorst in her play, Love and Shrimp:

    I made him swear he’d always tell me nothing but the truth.
    I promised him I never would resent it,
    No matter how unbearable, how harsh, how cruel.
    How come he thought I meant it?¹

  What is the cost of answering with the truth? In the situation above, telling the truth may result in temporary disapproval. What about when the stakes are higher? There are people around the world who know the cost of telling the truth is death. For example, in parts of the Middle East, residents are asked to which religious or political groups they belong. If they tell the truth, they may be subjected to horrible abuse and death! If you knew telling the truth was a life or death proposition, what would be your answer?

  If the price of truth is more than we want to pay, we tend to forgo it. In health care, being told the truth may be critical. We must have correct information about products and treatments if we are to provide the best care for our patients. Unfortunately, studies show we may not always be told the truth. It has been reported that up to 11% of information provided by pharmaceutical representatives may be misleading.² Not providing the truth may improve sales but at the cost of harming patients.

  Why do we forgo the truth? It could be to make ourselves look better in the eyes of others. To seem more knowledgeable than others is deemed desirable by many in our society. In parts of the world, knowledge is considered to be power, so information is rarely shared with others. In those cases, it is not unusual for people to claim to know much more than they actually do. During my first visit to Ghana, Africa, the people there were amazed that I was freely “giving” my knowledge about wound care to anyone who asked. The cost of my telling the truth about wound care meant to the Africans that I was giving my power away. One lady asked me why I was doing that, because she thought I should be protecting my power. I told her that my goal in coming to Ghana was to make her as powerful as I when taking care of patients with wounds, and that I expected her to pass the power she got from me to others so that they could help patients, too. She did not know how to respond to that!

  Many people fail to tell the truth because they do not want to admit that they might be wrong. It happens everyday in medicine. For instance, everyone has been exposed to the information that wet-to-dry dressings are “substandard” dressings and certainly do not represent good care.³ If everyone were truthful and admitted it, our patients would be doing much better. But is everyone admitting that the evidence clearly shows that wet-to-dry dressings should no longer be used? If so, why are wet-to-dry dressings still the preferred dressings for wounds by a margin of 5:1?³ The cost of this truth is admitting one is wrong, and the patients are paying the price with inferior care.

  Sometimes the cost of truth may be financial. Many treatments and procedures known to be ineffective are still in use today. I don’t mean to insult some of my colleagues but will use this example. Many patients at the end of life stop eating and drinking. This is nature’s way of providing an easy exit from this world. My mother, who recently passed away, suffered from severe musculoskeletal pain for the last several years of her life requiring narcotics to remain comfortable. The last few days of her life, she stopped eating and drinking. Even though she was awake and talking, she had no further pain and did not take any pain medication. Evidence in the literature supports the fact that terminal patients who stop eating and drinking do not have improvement or prolongation of life with the insertion of feeding tubes.⁴ If this is so, why do so many terminal patients have the devices placed? If the truth were told that these do little good, the cost would be lost revenue from placing and managing the tubes.

  There is a cost to truth. It may seem inconsequential at the time, but there is always a cost. We should tell the truth because it is the right thing to do and, ultimately, the cost will be worth it. I hope you agree.