Lying About Prognosis Might Not Be Lying

There is a lot of chatter (or here) about Lisa Iezzoni's study on physician openness and honesty, that was recently published in Health Affairs.  We've discussed the importance of disclosing medical errors numerous times, as well as the importance of disclosing financial conflicts of interest, so physicians who aren't honest in those domains, will get little sympathy here.  However, one aspect of the survey findings, I think, deserves more discussion, namely the disclosure of prognosis.

To quote from the article: "...more than half said that they had described a prognosis more positively than the facts warranted."

Is this really "lying"?  What is the importance of disclosing mean, median or mode survival?  Will patients or families even understand the difference?  How do you explain a normal or skewed survival curve?  If you can't describe the distribution or they don't understand it, is that dishonesty? Importantly, how does this all impact "hope"?

One article, written many years ago (1985) by Stephen J Gould, the Harvard evolutionary biologist, does a better job describing why "The Median Isn't the Message" than anything I could write. He tells how he reacted to his 1982 mesothelioma diagnosis. He lived until 2002. This essay has been highly influential to me throughout my medical career.