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Views & Reviews From the Frontline

The art of deception

BMJ 2013; 347 doi: (Published 02 October 2013) Cite this as: BMJ 2013;347:f5889

Rapid Response:

Re: The art of deception

Des Spence has quite rightly questioned the evidence underpinning guidelines for some treatments and also has questioned the wisdom behind certain aspects of conventional medical practice. (1) Unfortunately, Des Spence’s suggestion about not trusting patients and parents fails the high bar set by him. (2)

Trust permeates all aspects of patient-doctor relationship. High degree of suspicion and mistrust can backfire, and can affect the quality of patient-doctor interaction. Lack of trust would make the interaction just functional, albeit efficient, as in a bank teller or supermarket checkout transaction, to the detriment of patients’ well-being as well as doctors’ job satisfaction.

Where does mistrust stop? We know a minority of parents harm children (3) (4). Should we install Closed Circuit Video (CCTV) surveillance at homes of all parents not trusted by their doctors? And, do we label all patients with medically unexplainable symptoms as malingerers?

1. Spence D. Bad medicine: monitoring patients' drugs. BMJ. 2013 Sep 24;347:f5779. doi: 10.1136/bmj.f5779.

2. Spence D.The art of deception. BMJ. 2013 Oct 2;347:f5889. doi: 10.1136/bmj.f5889

3. Samuels MP, McClaughlin W, Jacobson RR, Poets CF, Southall DP. Fourteen cases of imposed upper airway obstruction. Arch Dis Child. 1992 Feb;67(2):162-70.

4. Tenney G, Wheatley R, Wheeler RA, Ade-Ajayi N, Kiely EM, Samuels MP, Southall D. Covert surveillance in Munchausen's syndrome by proxy. BMJ. 1994;308(6936):1100-2.

Competing interests: No competing interests

28 October 2013
Consultant Oncologist
Nottingham University Hospitals NHS Trust