Patients expect their doctor to make them better when they get sick, requesting the best care, the latest prescription medications, and the most advanced diagnostics available to aid in their recovery, explained Shelly K. Schwartz of Rosewell Park, a comprehensive cancer center.
However, patients oftentimes sabotage their own recovery by not disclosing pertinent information or lie to their physicians because they are afraid to be judged or lectured. Others do it because they want their doctors to see them in a positive light. Glen Stream, a primary-care physician with the Rockwood Clinic in Spokane, noted, “People might fail to disclose a serious risk factor like sexual practice or IV sharing, but the most dangerous is not being honest about what medications they are taking.”
Surveys Reveal the Prevalence of Lying and Non-Disclosure Among Patients
A survey conducted by TermLife2Go, a website dedicated to helping individuals find the best insurance coverage for their situation, found that 23% said they have lied to their doctors, reported Liz Meszaros of MDLinx, a daily medical news website, and Alex Enabnit of TermLife2Go. When the 500 respondents were asked “What do you lie to your doctor about,” 46% answered smoking, 43% said exercise, 37% said drinking, and 29% answered sexual partners.
More men lied to doctors about their alcohol consumption (50%) than women (32%). Meanwhile, more women (33%) lied to doctors about sex than men (22%). For those who lied (75%), their primary motivation was to avoid embarrassment. 31% of participants also lied because they want to avoid discrimination while 22% chose to do so because they did not think their doctors would take them seriously if they told the truth.
One man lied about his alcohol intake because he did want to be lectured by his doctor. One woman also lied because she did want her mother, who was in the same room, to find out about her sexual activity. Among those who had admitted to fibbing to their doctors, more women (80%) than men (20%) lied to avoid discrimination. However, 77% of the respondents were honest with their doctor.
This does mean that honesty is equated to comfort. For instance, half of the survey respondents reported feeling uncomfortable talking to their doctors about their sexual activities. One person said she is uncomfortable talking with her doctor about anything because she does not trust doctors. In contrast, 34% of respondents admitted that they were comfortable talking with their doctor about anything.
Published in the open-access medical research portal JAMA Network Open, a 2019 survey conducted by Andrea Gurmankin Levy and colleagues found that 7% and 31.4% of MTurk (Amazon’s Mechanical Turk) and SSI (Survey Sampling International) respondents, respectively, avoided telling physicians relevant information because they do not agree with their doctors’ recommendations, cited Meszaros.
8% and 24.3% failed to understand their physicians’ instructions and 5% and 20.3% said they did not report an unhealthy diet. 5% and 21.6% did not say that they did not take their prescription medications as instructed. 5% and 10.4% of MTurk and SSI respondents, respectively, said they deliberately did not mention taking certain medications.
As for the respondents’ motivations in choosing not to disclose information to their doctors, 8% of MTurk and 64.1% of SSI respondents did so because they did not want to be lectured or judged. 7% and 61.1% said they did not want to hear how harmful their behaviors are and 9% and 49.9% reported feeling embarrassed. Further, 8% and 38.1% of MTurk and SSI respondents, respectively, said they did not want their doctors to see them as difficult patients and 2% and 35.9% said they did not want to take up more of their doctors’ time.
How Do Doctors Know When A Patient Is Lying?
There is no sure-fire way for doctors to find out if their patients are lying, but they can use their gut instinct and other methods to determine whether their patients might be holding back. Fred Ralston, an internal medicine specialist with Fayetteville Medical Associates in Fayetteville, Tenn., and president of the American College of Physicians, stated, “When you ask them a question like, ‘Are you exercising?’ and they wait awhile before they answer I know they may not be telling the truth.”
If the patient is exercising 45 minutes a day for five days a week, then they are more likely to tell their doctors right away, said Ralston. Some suggest “guilty” body language such as fidgeting, avoiding eye contact, and nodding dutifully in agreement are signs that may suggest that a person is lying, stated Jeffrey Knuppel, a correctional psychiatrist who treats prison inmates.
Although he acknowledged that non-verbal cues are unreliable at best, people assume that it takes more work to lie than to tell the truth. Knuppel also debunked the assumption that individuals lie because they are nervous. In fact, lying comes naturally for some people, as telling the truth may cause them to become more anxious, he added.
What Can Doctors Do?
Doctors should take into account their patient’s motivation. Knuppel suggested, “It’s good to develop a healthy skepticism — not to become cynical, but to think about their responses in terms of what might be at stake for this patient.” Physicians can also review medical histories before seeing their patients.
According to Knuppel, doctors are more likely to spot inconsistencies in their patient’s words the more physicians review their medical records. Additionally, it is helpful if doctors could get copies of their patients’ medical records from other hospitals or clinics, especially if they are new patients or may be suspected of misleading their physicians. Knuppel reminded, “It still doesn’t mean they’re not lying, but the records themselves can help clarify their medical history and that increases the trust factor.”
Making Patients Aware of the Consequences
If patients lie about the medications they take, for example, their doctors may administer drugs that may have serious health consequences, said Joanne Finegan of Fierce Healthcare, a healthcare industry news.
Doctors may also be forced to play hardball if the stakes are high or when non-compliance or lying becomes life-threatening. Medical professionals should inform their patients that their next treatment plan will be more aggressive and unnecessary — which could include surgery or stronger medications — if their current treatment fails. “It helps to frame the discussion in the context of what they’re going to miss out on in their life if they don’t take care of their health.”
It can be difficult for patients to tell the truth about their health for fear of receiving backlash from their doctors or from embarrassment. Medical professionals should be emphatic to help patients open up, but doctors should also help them be aware of the consequences of lying.