Come on, ‘fess up. Have you ever told a "little white lie" to your doctor?
Whether you're stretching the truth, leaving out embarrassing information or telling a big, fat lie, the consequences could be detrimental to your health. So, why do we sometimes lie?
For doctors to make an accurate diagnosis, they need reliable information from patients, medical experts say. And in this electronic age, email and digital medical records can create fewer opportunities for face-to-face communication. If they go unchecked, untruths and manipulation of information can damage relationships and compromise clinical care.
So why do we sometimes lie? Here are 12 common things patients might fib to their doctors about:
1. How much alcohol you drink
2. How much you smoke
3. Whether you're taking your medicines as prescribed
4. Using alternative medicines or supplements
5. How much junk food you eat
6. Number of sexual partners, sexual orientation or unprotected sex
7. Chest pain or shortness of breath
8. Rashes, growths or genital lesions
9. Recreational drug use, including prescription medications
10. How much exercise you get
11. That you might be depressed or have suicidal thoughts
12. Family history of disease
We asked Dr. Milah Blinka Frownfelter, who is board-certified in internal medicine and practices at the Polyclinic in Seattle, Wash., to try to explain why honest doctor-patient communication is so important, and why it sometimes just doesn't happen.
On the popular TV series House, one of Dr. Gregory House's favorite sayings is "patients lie." Do you have any experiences to support that?
I had one patient who lost his job and was no longer able to afford his medications. Embarrassed that he had lost his job and had limited income, he told me that he was taking his medications as prescribed and did not mention the change in his professional circumstances. Later, he was seen in the emergency department with heart failure that had been well controlled by medications that he was no longer taking.
Why do we sometimes omit certain information?
Some patients may fear that their behavior may cause disapproval, judgment, anger or disappointment on the part of their provider. Some people may feel embarrassed about their personal situation or fear being reprimanded for bad behavior. Others may be concerned about long-term consequences associated with disclosure of information that may create barriers in their ability to get life or health insurance in the future or that may increase their premiums (for example, the history of a pre-existing condition or smoking). With the advent of the electronic health record, many people have concerns about their privacy and the security of data within the system and so may withhold important information.
Is honesty always best?
As is said, "honesty is the best policy." If required, an intervention can be discussed to help with the situation, diagnose or screen for a disease process, or appropriate counseling provided. In the example above, had I known that there were difficulties in getting prescribed medications, I could have referred the patient to a social worker who could work with him to find low-cost medications or medications through a patient assistance program.
Have you seen cases where someone was underinsured or not insured and was reluctant to get certain tests?
People are definitely rationing their health care and being mindful of how they spend their health care dollars. That said, for medications and tests that are clearly medically necessary in matters of life or death, arrangements can always be made to achieve the care plan. In some circumstances, patients can be referred to community health practices where the out-of-pocket expense is less. Some may choose to cover expenses through a flexible savings account or health savings account. Or there may be arrangements that can be made for a financing option with smaller, monthly payments.
Can you tell when we're withholding information or stretching the truth? What are some of the hints you might look for?
I am most concerned that someone may not be forthcoming when I see suggestive body language or other cues: shifting gaze, sweating, flushing, fidgeting, decreased or increased vocal tone, making attempts to change the subject or looking away.
What are some of the possible consequences of not telling everything?
The consequences of not being honest or avoiding the truth are multiple:
- Letting a silent disease go undiagnosed and therefore, untreated
- Suffering greater harm as a currently stable disease may worsen unnecessarily
- The potential for placing others at risk (particularly, in matters of alcohol or recreational drug use or surrounding safety issues in the elderly)
- Being exposed to unnecessary testing and therefore, additional expense
- And missing an opportunity for important counseling that may affect behavior to positively influence disease progression or secondary outcomes (for example, smoking cessation counseling in a patient with diabetes to reduce the risk for stroke and heart disease).
How would you likely deal with the situation?
I reaffirm the confidential nature of the patient-physician relationship and assert my sympathy for the patient so that she or he may feel more confident in opening up to me. I often ask the patient the same question, but in a different fashion or ask an open-ended question that feels less threatening, so that the patient feels more comfortable in being honest.
Do physicians get specific training for this kind of thing?
To my knowledge, there is no specific training in how to deal with these situations -- although I know through training in medical school and residency, there is an emphasis on patient-centered communication that is likely to be helpful.
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