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CAMHS won't see you now

I lied to a patient. But come on, you do it too. Don't you?

Copperfield wants your answers to his ethical dilemma. Well, sort of. Because he also sort of wants reassurance that he was doing the right thing when he lied to his patient.

Copperfield wants your answers to his ethical dilemma. Well, sort of. Because he also sort of wants reassurance that he was doing the right thing when he lied to his patient.

OK, answers please.

Very anxious hypertensive patient comes in with what is clearly a tension headache. Wants blood pressure check to make sure it's not his systolic about to blow his head off. Check blood pressure: it's180/90.

Here's the background. You know his BP's well controlled – two recent readings were fine. You know it's up today just because he's anxious – it's obvious, and he has a tachycardia.

You know his headache has nothing to do with his transiently raised BP. And you know if you tell him his BP's a bit elevated you'll aggravate his anxiety, you'll create further dysfunction and you'll make more unnecessary work for the future.

I know what you'll say. I shouldn't have measured it in the first place. Spot on. But explaining to a patient that a BP check in this situation is not only misleading but potentially harmful is, in a case like this, about as satisfying as chewing glass.

He won't listen, or, if he does, he won't hear or, if he does, he won't understand or, if he does, he won't be happy, so he'll go off to someone with a less, er, ‘global view' of his problem and screw himself up further. So I reckon most of us end up doing what we know is useless but what seems expedient. Until it backfires.

What then? I could repeat it after he's rested for a while. That, of course, prolongs the agony. Plus, resting in this context just means him winding himself up more.

I could tell him it's a bit up. And then explain that this is normal in these circumstances, that it's not the cause of his headache, that if he wants we can repeat it in a week or so, when he's feeling less tense. Trouble is, he stopped listening at, ‘a bit up'. And I can already see his anxiety going into overdrive.

So I'll tell you what I do. I lie. No, really. I tell him his BP is ‘fine'. Which I can defend in that it's a white lie, it's not saying it's ‘normal' as such, and besides, on balance, it's in the best interests of the patient.

But it's still a lie, and I feel a teensy bit uncomfortable with it. I don't believe I'm being dangerous, or neglecting my patient. I'm lying simply because the truth is just inconvenient, inappropriate and impossible to convey. Lying is much kinder and certainly a lot quicker.

What about you? You see, the irony is I want my own anxiety allayed. I want to know you lie to patients, too, albeit in a benign way.

And also, I'd like to know if anyone has an aneroid sphyg. that is mysteriously missing the pointer on the dial. That would do the trick.

Copperfield blog: So I lied to a patient. But don't we all? Recent Copperfield blogs

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