Despite our best intentions, humans aren’t always the most honest of species. From little white lies to selective reporting and glossing over of details, there are a lot of ways that we skirt the truth. And we’re more likely to do so when the topic is sensitive or makes us uncomfortable in some way.
It probably shouldn’t come as a surprise then that people aren’t always completely honest with their doctors. A recent study published in the journal JAMA Network Open found that 60 to 80 percent of patients have been less than fully forthright with their doctors at some point. That’s a lot of untruths told for a wide variety of reasons.
Lead author Angela Fagerlin, professor and chair of population health sciences at University of Utah Health and a research scientist with the VA Salt Lake City Health System‘s Informatics Decision-Enhancement and Analytic Sciences Center for Innovation, says the team conducted the study because “we wanted to see and to understand how many people misled their physicians about different components of their health care.”
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
To do that, the study surveyed two groups of people: The first consisted of 2,011 people ranging in age from 19 to 79 (mean age 36) and the second had 2,499 people age 50 and older (mean age 61). Both surveys, administered as online questionnaires, asked participants if they’d ever avoided telling a health care provider the truth for one of several reasons including:
— Not understanding the provider’s instructions
— Disagreeing with the doctor’s recommendation
— Not exercising at all or not exercising regularly
— Eating an unhealthy diet
— Taking a certain medication
— Taking a certain medication incorrectly or counter to its instructions
— Taking someone else’s prescription
“We found a lot of people admitted to not telling their physician everything that they could have,” Fagerlin says, and this is problematic because withholding relevant information could lead to dangerous outcomes. Any one of the reasons for lying listed above could potentially have negative consequences, Fagerlin says.
Many of these cases of fibbing or omitting details are completely understandable when you look a little closer at what’s happening in individual scenarios. Fagerlin points to the example of a patient who’s already taking four medications to manage several conditions and is being prescribed a fifth drug. “The doctor could say, ‘we need to put you on blood pressure medication,’ but the patient thinks, ‘ I can’t afford another medication,’ or ‘I don’t want the hassle,’ but they’ll nod their head and the physician will write the prescription. But the patient won’t fill it. They act like they agree, but they don’t.”
In some instances, it could be that another medication the patient is taking would be the better one to stop taking or substitute a cheaper alternative for, and the patient would then be able to afford the fifth drug. But the only way such a resolution can come about is if the patient speaks up and tells the doctor about whichever barrier he or she is experiencing that’s preventing taking the prescribed medication. “If they had talked to the physician about this, the doctor might have said, ‘if you can only afford four, it’s drug number two you should drop. That one probably has the least impact.’ But this can only happen if they voice the concern.”
Similarly, Fagerlin says another concerning finding was that about a quarter to a third of study respondents (32 percent in the younger survey and 24 percent in the older survey) said they didn’t understand the clinicians’ instructions. This can result from a doctor being hurried or not realizing that medical jargon has elbowed into the conversation. “Sometimes they say things so fast with so many words” that can overwhelm even the most educated and intelligent of patients. “I’m in the health care system and even I have no idea what (the doctor says) sometimes,” she says.
But people are often reluctant to speak up in these situations because of the innate power dynamic that can sometimes arise in the doctor-patient relationship. “People don’t want to look stupid. It’s hard to admit not understanding in that power dynamic,” where the doctor has knowledge and understanding that the patient is often excluded from. “But it’s very obvious where that can go very bad, especially with medications,” she says, as miscommunication can lead to dangerous drug interactions or incorrect prescriptions.
The fact that 20 to 25 percent of respondents said they weren’t honest about their eating and exercise habits wasn’t shocking, but the percentage who admitted to this deception was somewhat surprising, and likely just the tip of the iceberg, Fagerlin says. “We’re asking people to admit to being dishonest. That’s a hard thing to do.” She says the actual incidence of lying could actually be quite a bit higher for many of the reasons cited in the study because some patients might not realize they’re doing it, have forgotten they did it or because they won’t admit to misleading a health care provider.
[See: HIPAA: Protecting Your Health Information.]
Another surprising finding was that younger people tended to be more dishonest — or at least more likely to admit to being less than fully honest with a doctor — than older patients, Fagerlin says. The first sample group that had the mean age of 36 had higher percentages of fibs reported. Given that “as you age you often have more comorbidities and visit the doctor more, that amounts to more opportunities to mislead” a health care provider, so the researchers thought they’d get a higher number in the older group. But the results suggest that younger people were more likely to lie. The reason why seemed more to be because younger people “‘didn’t want to be judged or hear how bad my behavior is,'” she says. Women and people who reported being in poorer health also seemed more likely to lie to their providers, the survey found.
So how can doctors help patient bridge this honesty gap? After all, with good health and safety at stake it seems that complete openness and honesty should be an important goal for any doctor-patient relationship. “I think there’s room on both sides” to improve communications, Fagerlin says.
Dr. Gary LeRoy, a family physician at East Dayton Health Clinic in Dayton, Ohio and president-elect of the American Academy of Family Physicians, agrees that both patients and providers have a duty to communicate openly and honestly. He notes that providers may have to dig a little to get the full story from certain patients but it can be done successfully with careful, nonjudgmental probing. “It’s taking the time to have the conversation. I know in this fast-paced world. we want instant gratification for whatever we’re seeking. It’s difficult for people to stop for a moment and talk. But the first thing that I remember one of my mentors teaching me in medical school when we were talking about interviewing patients was to look them in the eye. Sit down at their level and have a meaningful conversation with them. I think that disengages the individual who wants to not be as forthcoming as you would like.”
Sometimes he’ll ask the same question in multiple contexts and seek clarification if it seems a patient isn’t being fully truthful. “You ask them open-ended questions but you keep tightening up the questions as you get answers.” In addition, he looks for non-verbal clues such as fidgeting, long pauses before answering and anxiety — not in an effort to expose a lie for the sake of exposing the liar, but in the pursuit of what’s actually going on so he can help the patient to the best of his ability.
Offering a very direct assurance that the doctor is there to help, not to judge, can go a long way toward helping many patients open up and feel more comfortable sharing everything, he says, and Fagerlin adds that “providers want to help patients and give them the best care possible. They’re not going to judge you for the most part. They want to help you, but they can’t serve you well and protect your health if they don’t know everything.” It all comes back to good interpersonal communication. Patients have to speak up and doctors need to listen.
Still, it can be difficult for patients to fully engage in honest dialog with a doctor sometimes because of simple social reasons. “People tend to want other people to think highly of them. It can be hard to admit a failing or mistakes or things that put you in a less positive light,” Fagerlin says.
Getting more comfortable with a particular provider may help some patients open up, but for others, this closeness can actually make it more difficult to tell-all. “It can cut both ways,” LeRoy says, and some patients who would benefit from consistent care might avoid doing that because they’re uncomfortable being honest with a family physician or primary care provider. “In this day and age of convenience medicine where you see whomever is available or you go to one of these places at the drugstores and see somebody — you don’t know them and they don’t know you. And so you tell them what you want to tell them to get what you want to get, and then you want to move on. Sometimes that can be detrimental to the patient’s health outcome as opposed to someone that’s been seeing them on a regular basis.”
Particularly when it comes to delicate questions around lifestyle or behavior, such as sexual practices or drug use, societal taboos can make it even more difficult for patients to tell a provider the full extent of what’s going on. It might be easier for some patients to talk to a doctor they’ll never see again about erectile dysfunction or a sexually transmitted infection, for example, but then you lose continuity of care and the benefits that can provide in ongoing support and treatment.
[See: 14 Things You Didn’t Know About Nurses.]
In other situations, LeRoy says patients will broach particularly difficult topic with so-called “doorknob comments,” where a patient will mention something potentially very important just as the appointment is concluding because they’ve been too scared or uncomfortable to tell the doctor upfront that this issue was the reason for the appointment to begin with.
To help reduce the chances of these doorknob comments, LeRoy uses an intake form that asks patient why they scheduled the appointment and to list their concerns in order of perceived priority. This exercise gives patients the opportunity to think about why they’re really there and remind them what the goal of the appointment should be. For some patients, it’s easier to share what’s going on in writing, rather than saying it out loud. It also “shows me what they think their priority is because sometimes there’s a disconnect between what the doctor thinks is a priority and what the patient’s priorities are.”
LeRoy adds that often, lies or half-truths uttered in the doctor’s office are misguided attempts at just being liked. “The vast majority of our patients want to be good patients. And in the process of wanting to be a good patient they may omit certain things such as ‘I have not been taking my medications the appropriate way because I can’t afford them,’ or ‘I forget them,’ or ‘I don’t want to share that with a trusted physician or caregiver.'” He says this can present a challenge for the family physician, who has the benefit of knowing a patient well, which may make the relationship more complex. “I’ve been taking care of some of my patients for a decade or more, and so I often refer to them as part of my extended family. And so they want to please me in that sense. Sometimes it’s very important to tell the patient how important the truth is to the appropriate care for them.” Other patients say they don’t want their provider to think they’re “difficult” or they want the provider to like them. “People in general we don’t want to be broken,” LeRoy says.
No matter what’s driving a patient to be less than 100 percent truthful, the bottom line, Fagerlin says, is that withholding details from your provider can have consequences, so it’s best to fess up, no matter how hard it is. “Even if it’s really hard, tell your doctor what you’re thinking and what you’re doing.”
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Why Do Patients Lie to Their Doctors? originally appeared on usnews.com
