Have you ever said, “I’m going to be perfectly honest with you” or something to that effect?  Have you ever had someone tell you that they were going to be perfectly honest with you?  Have you ever thought about what statements similar to these really mean?  You should.

Trust is an earned commodity and hard to get back once lost.  “Doc, I’m going to be perfectly honest with you” means that, in the past, my patient has not been honest with me. Everyone knows there are consequences to being dishonest.  In this case, the first consequence is that I feel foolish for assuming that you were honest with me in the past.  You know what they say about “ass-u-me.”  The second consequence is I will never know if I should believe what you tell me in the future.  Both consequences compromise medical care.

Being honest is not easy.  Being honest can hurt someone’s feelings, reveal your weaknesses, and make you vulnerable.  Being honest does not necessarily come naturally to many of us.  When Renee asks me, “Do you like my hair?” and I don’t, my choices are dismal.  “I love it” means that I am being dishonest and the consequence is she is likely to have it done in the same style in the future.  Being honest means I hurt her feelings and consequently am not likely to get lucky for a while.

Perhaps, there is a middle of the road approach.  “Can I be perfectly honest with you?” is similar to “Doc, I’m going to be perfectly honest with you,” but different.  The difference is that “Can I …” is asking permission and signals your intent to say something that may be hurtful or sensitive material.  “Renee, can I be perfectly honest with you?” gives my wife a chance to say, “No, I’ve had a rotten day and don’t want to hear anything negative.  I don’t like it either.”

When it comes to your medical care, “perfect” honesty is essential.  When it comes to the rest of life, I’ll leave the decision to you.  It’s important to understand the implications of such a simple statement of fact.  I’m going to be perfectly honest with you.  I would appreciate it if you are honest with me and I will be honest with you, even when I know you don’t want to hear it.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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