Have you ever lied to your doctor? You're not alone
They say honesty is the best policy. Patients may beg to differ. A study published last week in JAMA Network Open shows just how often patients fib to their doctors. A lot more than patients and doctors might have realized.
Researchers at the University of Utah Health and the Veterans Administration in Salt Lake City conducted two national online surveys. One involved just over 2,000 younger participants, and a second survey of 2,500 participants who averaged 61 years of age. Participants were shown seven common scenarios in which a patient might be tempted to conceal health behaviours from their clinician. They were then asked to select the behaviours about which they had actually lied about to their doctor.
As many as 80 per cent of those surveyed admitted they have not been forthcoming with their doctors about information that could be relevant to their health. The people who were more likely to conceal their behaviour from their doctors were women, younger patients, and those who rated their own health as poor.
The things they lied to their GPs about should come as no surprise. They fibbed about their unhealthy habits. Some said they get regular exercise when they don't. Many said they eat healthy food when their diet is actually high in carbohydrates. Some lied about how much they smoke and how much alcohol they drink.
I have seen patients who have concealed their use of recreational drugs and their unsafe sexual habits. In my experience, some of what they lie about is contextual. Some patients who have needed a sick note or a medical report justifying their absence from work have exaggerated their symptoms, and some have fibbed about the timing of the onset of their illness.
Occasionally, I have seen a patient who is perfectly well, and wants to obtain medication for a partner who is ill but not covered by the patient's drug plan.
The study found several reasons why patients were motivated to lie to their doctors. The biggest reason was not wanting to be judged or lectured. The second most important reason was not wanting to hear how harmful their behaviour is. The third reason was not wanting to be embarrassed. Another reason is that some patients were reluctant to admit they couldn't understand the doctor's instructions.
The study's authors concluded that most patients want their doctors to think highly of them. They did not like the idea of being judged.
Some patients fear being judged harshly by their doctor. I've also met patients who resent the idea that their doctor judges them at all. This is true if they feel that their GP does not know them all that well. It is also true if they believe their doctor does not respect them.
In some cases, lying occurs when doctor and patient don't share the same values. I'm not condoning unethical behaviour by physicians or patients. That said, it stands to reason that a patient is more likely to be truthful about a request to write a prescription for a family member in the patient's name if he or she knows the physician is likely to do that sort of thing.
Lying comes with some obvious harms. If the patient cannot understand the doctor's instructions, there's a good chance they won't benefit from the doctor's advice. There's a good chance they won't take the doctor's prescription correctly. If patients are withholding information from doctors as frequently as this research suggests, then doctors won't receive the information that they need to provide high quality care to patients.
Patients only fooling themselves
If sicker patients are more likely to lie, as the study suggests, that might mean the health consequences of lying might be profoundly serious.
If patients conceal bad health habits from their doctor, they're only fooling themselves. They're missing an opportunity to at least start the process of quitting smoking, exercising, improving their diet and entering recovery from alcohol and drug misuse.
There are ways to increase the accuracy of information in the doctor's clinic. As reported, there's a urine drug test that demonstrates whether the patient is actually taking the medication their doctor has prescribed. Although it's not intended as a lie detector, doctors who have tested it are hoping it acts as a deterrent to fibbing.
A journal article aimed at family doctors recommends that physicians negotiate in advance with patients what they're willing to talk about frankly, and to what extent. The article also recommends that truth be looked upon as a process and not as an outcome.
I know some colleagues who fire patients after the first lie. I believe there's room to discuss the reasons why the patient lied. Some patients fear being rejected and lie to prevent it.
This leads me to an important piece of advice for my colleagues. I think we need to stop being overly judgmental with our patients. Being judgmental evokes a shame response in patients, which in turn makes them even more likely to lie. Tone down the judgment, and you keep the lines of communication open.
Hopefully, that helps patients be their true selves with their doctors.