We know why humans lie. It boils down to looking good to others and ourselves.
University of Massachusetts psychologist Robert Feldman posits that this kind of activity is tied to our self-esteem levels. We lie to defend ourselves when we feel threatened.
To a certain extent, lying is a defense mechanism tied with survival and can probably save lives in more than a few cases. Since this is the case, isn’t it counterintuitive to lie to your physician, the person in charge of facilitating your survival?
Nevertheless, patients deceive physicians – often senselessly. Below we examine a number of reasons why they do and what you can do about it.
Why Do Patients Lie?
Dr. Gregory House, the namesake protagonist of the hit medical tragicomedy House, famously said he won’t “ask why patients lie, [he] just assume[s] they all do.” Catch another House quote on lying.
Despite his cynicism, there is truth to the statement. Your job isn’t to point this out, however. You know patients lie about symptoms, adherence to medication regimens, diet and exercise, and substance abuse.
There are several explanations for this kind of behavior. The first, embarrassment or fear of chastisement, is probably the most obvious. It’s also the least beneficial.
Withholding personal health information can also lead to cheaper health insurance, but the tradeoff could be potentially fatal for patients with chronic diseases like diabetes. It can also help them land or maintain jobs. As a patient, you certainly don’t want to admit to substance abuse issues while you’re searching for employment.
Also, patients lie to obtain security clearances or to join the military. If you’re a physician examining a potential Army recruit, odds are he or she won’t divulge sensitive health information, i.e., alcohol abuse or mental illness. Factors that could compromise his or her enlisted status will likely be omitted.
A number of soldiers at war will choose to lie about ailments like Post Traumatic Stress Disorder (PTSD) as well, for fear of being discharged or ridiculed by their peers.
Patients don’t only withhold information, either. For instance, Patient X may want to nab an appointment before he or she is due by exaggerating symptoms. Patient Y may even coerce doctors into ordering more extensive diagnostic procedures.
Patients may also exaggerate symptoms – sometimes associated with pre-existing conditions – when filing for disability benefits after a car accident or workplace injury, namely in search of compensation.
Lastly, patients are often asked to sign a number of release-of-information forms by third-party payers, employers, and attorneys. In such cases, patient-doctor confidentiality goes out the window and often forces patients to feel endangered and vulnerable.
What Do You Do?
I’m sure you don’t have a polygraph handy, and chances are it’ll be tough to get your patients to sign consent forms. So what are your options when dealing with a lying patient?
There is no guaranteed way to know whether your patient is deceiving you, but there are tools you can use to try and gauge his or her level of honesty.
Hesitation is the most apparent. If a patient noticeably hesitates when answering questions about diet or exercise, he may be stretching the truth. Chances are a patient can immediately answer questions about routines when they’re things he practices daily.
Think of patient history to discern motivators. There is much for patients to gain or lose from healthcare encounters, so stack their responses up against what you think may or may not benefit them.
The location should be taken into account as well. Substance abuse and terminated pregnancies may be easier to admit in a city like Los Angeles, but perhaps not as readily discussed in a small Kansas municipality.
Beware of putting too much emphasis on non-verbal cues. It’s a common misconception that fidgety body language – such as inconsistent eye contact and exaggerated head-nodding – indicates dishonesty. For questions about compromising or taboo health information, it may just be more difficult for patients to tell the truth.
As a physician, you should try to understand the reasons why patients lie instead of calling them out on it. Use previous experiences with patient deceit to formulate more pointed questions, and incorporate new honesty-inducing techniques into future patient engagements.
Choose practicality over judgment – no snickering and no jabs. But maintain awareness. If a patient smells like smoke, chances are he or she is still smoking, even if it is less frequent. There are similar lifestyle indicators for obesity or substance abuse.
It’s still your job to guide them towards better decisions as a patient, regardless of what information they choose to divulge.
Have you had many experiences with patient deceit? What have you done to try and get around it?
Should doctors lie to patients? Check Power Your Practice tomorrow for different angles on the subject of lying in the patient-physician relationship!