“We’ll have to invent symptoms,” the doctor said. Since this physician was a paragon of integrity, the patient gasped. With what words could she thank the doctor for such a breach of insurance rules?

Many have fulminated against oncologists who lie to patients about their prognoses, but sometimes cancer doctors lie for or with patients to improve our chances of survival.

Here’s the back story in this case. The patient, a woman in her early 50s, was given a diagnosis of endometrial cancer. After three infusions of chemo, she was supposed to start radiation, but imaging for it detected tumor growth. In other words, her disease was so malevolent that malignancy progressed during treatment. Yet physicians successfully altered the regimen, which she weathered. While some women with gynecologic cancer can use the CA125 blood test as a marker for recurrence, for others it does not work at all; they need scans. This patient is in that category, so she and her oncologist agreed to rely on a CT scan every nine months.

However, the insurance company refused to pre-certify the patient’s scan on the grounds that she had no symptoms of recurrence. Both she and her oncologist were baffled. Three specialists had warned that her cancer would probably return. Umpteen forms, filled out and submitted, failed to change the verdict; the oncologist fumed at insurance representatives on the phone, but to no avail. The doctor then coached my friend to fabricate cramping or bloating — symptoms that the insurance company might see as justification for the scan.