Alt-Health: Little White Lies Lead to Big Problems

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PD Ouspensky once wrote that man could be classified as “an animal that lies.” This is most certainly true. Much of the time, it can be a harmless feelings-sparing, or time-buying, act, but sometimes it can be dangerous.

According to a recent study published in JAMA (Journal of the American Medical Association), 60% to 80% of patients lie to their doctors. Considering that those are the professionals with whom we trust our lives, the results can have serious consequences for our health.

There are some valid and logical reasons why patients are reluctant to reveal their deepest secrets. More and more, the medical record is not confidential, and patients don’t want embarrassing or potentially damaging facts to be revealed in the matter of court cases, disability cases, insurance coverage or other legal proceedings. However, the majority of fibbers are motivated for entirely personal reasons.

What do patients lie about most? According to my friend Dr. H, it’s drinking. He generally multiplies whatever the patient tells him by 2. Unfortunately, alcohol can cause some of the more dangerous reactions when mixed with other drugs because it affects the central nervous system. When mixed with other drugs (such as opioids, muscle relaxers, sleep aids, antidepressants, etc) the result can be a fatal overdose. Even seemingly innocuous over-the-counter drugs, such as acetaminophen, can cause liver damage when combined in excess with alcohol. And if you are a diabetic, drinking can lower your blood sugar to dangerous levels.

Another thing patients lie about is their diet. Overweight patients are embarrassed to admit they are in not, in fact, eating fruit and yogurt for breakfast but are instead downing an entire box of Little Debbie coffee cakes. This particular lie is somewhat pointless since your doctor will know exactly what you are doing by your blood tests, blood pressure and a quick trip to the scales, but the instinct to cover up our overindulgence is irresistible. It’s as if we are teenagers again, trying to sneak into the house at 2am without waking up Mom and Dad.

This raises a point – our doctors are perhaps the closest we come in adult life to feeling like we are kids answering to our parents. Dr. H tells me that it is not uncommon for patients to lie to him about not taking their medications, only to tell his medical assistant the truth immediately afterward. It’s like we want our doctors to be proud of us, to think well of us. But the truth is, there is no one who is less interested in judging us and more interested in helping us than our doctor; and we can undermine our best chances at getting help when we deceive him or her.

Sometimes, patients lie because they have been given a prescription, or advice, that they cannot fill. A doctor recommends a treatment that is out of their price range or ability, and the patient nods and pretends to go along, but doesn’t. They don’t want to admit that they can’t. The thing is, it’s very possible that if they told the doctor about their difficulty, they may have been able to find another option. Your doctor genuinely wants you to get better – if for no other reason than that it improves their patient outcome records.

The lies that doctors used to be most on the lookout for were from patients who exaggerated or fabricated the severity of their symptoms in order to get their hands on controlled substances. However, in the wake of the opioid crisis, doctors get so much blowback for prescribing them that now everyone knows they ain’t gettin’ Vikes or Percs unless the source of their pain is obvious. Then there is the opposite side of the coin: patients who downplay the severity of their symptoms. Again, this is information your doctor needs to know; increased discomfort can be a sign that a different prescription or treatment is needed.

Every doctor has been lied to, but in the end, the truth usually comes out, and a doctor who has known you for more than 20 years catches on much faster than a specialist you have just met. But this value in long-term relationships is totally ignored by incentive payments with healthcare today, which is unfortunate; if a patient doesn’t tell the truth, or, much more commonly, tells less than the truth, even specialized treatment is less effective. Because of this, a good doctor takes the time to develop the skills to bring out the truth. Dr. H finds that asking open-ended questions tends to get truer responses, and that it’s harder for a patient to lie when asked repeatedly. He also repeats back his understanding to the patient, which prevents any misunderstandings. 

What happens when a patient is caught in a lie? Nothing – except the opportunity to admit to the truth. Patients need to realize that it is not their doctor’s intention to judge or to praise them. It’s their job is to help patients keep their health. If you will be honest, there’s a much better chance that they can.