By Jennifer Larson, contributor Dec 17, 2018
Have you ever suspected that a patient wasn’t telling you something
important, something that might impact their care?
They disagree with your recommendations (and may
not follow them)
They don’t understand the instructions or recommendations
that you provided
They’re not eating a healthy diet
They’re not taking their prescription medication
as you prescribed
They’re not exercising regularly
They are taking another medication they’re not
telling you about
They’re taking someone else’s prescription
You’re not alone—and you’re probably right. A study
published online on November 30 for JAMA
Network Open suggested that “a substantial proportion of patients withhold
important information from their clinicians.” Some actually lie to their
clinicians, while others just don’t admit the entire truth.
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Common patient lies and
Here’s what your patients may not be telling you, according to the
Why patients lie
Why do patients lie—or at least, why are they not telling you the whole
truth? The researchers found that it’s often because they don’t want you to
judge them, and they don’t want you to lecture them about their behavior if
“They already know. They just don’t want to hear it again,” said Angela
Fagerlin, PhD, the study’s senior author and chair of population health
sciences at University of Utah Health.
In fact, there were several reasons that the people surveyed reported
not always being completely forthcoming with their clinicians.
“They were embarrassed, or they didn’t want their doctor to think badly
of them,” Fagerlin said.
But patients are most likely to withhold information when they disagree
with or misunderstand their clinician’s instructions.
“We need to do a lot to improve the conversations
between provides and their patients,” Fagerlin said. “We need to
make sure that patients understand that they’re not going to get different care
based on whether or not that provider likes you.”
When lying has serious
While some patient lies or omissions may not have serious consequences,
others can lead to life-threatening situations.
As the authors of the study wrote, “Patient disclosure to clinicians is
an essential element of the clinician–patient relationship. Clinicians rely on
patients to disclose their symptoms, health behaviors and thoughts and feelings
so that clinicians can make appropriate diagnoses and treatment
recommendations. Without accurate information, clinician recommendations and
decisions may even harm patients.”
For example, a clinician might prescribe a medication to a patient
that’s contraindicated without realizing it if they aren’t informed about all of
the medications, including over-the-counter drugs, that the patient is actually
“We need to make sure that patients understand what the consequences
are,” said Fagerlin.
Using discernment and building
Is it possible to know if a patient is lying to you? Sometimes, but not
always. You might be suspicious, but it’s important to consider how to best handle
that situation, and how it may affect your ultimate goal to provide the best
care for your patient.
“It’s a very delicate situation,” noted Nancy Brook, MSN, RN, CFNP, a
nurse practitioner and author of a career guide, The Nurse Practitioner’s Bag. “We want to provide the best possible
care to our patients but if they are not giving us accurate information or an
honest history, it is very difficult to treat or prescribe appropriately.”
Clinicians can take care to make their patients feel more comfortable,
more willing to share.
“I think it’s going to take some self-reflection,” said Fagerlin.
If something seems amiss, Brook recommends that clinicians follow their
“If the history and physical do not ‘line up,’ or the patient is
sharing contradictory information, we have an obligation to pursue further
questions and try to obtain more information,” Brook said. “Ask clarifying
questions, and if it does appear the patient is withholding information or
being dishonest, I would ask in a non-confrontational way.”
“I always remind my patients that I want to provide the safest and most
appropriate care, and without honest information, I cannot do that,” she
Empathy is essential to a primary care clinician’s diagnostic process,
said John Cullen, MD, a family practice physician in Valdez, Alaska. Sometimes, a patient is waiting to see how
their clinician reacts when they reveal some information. If the physician
seems empathetic and receptive, they may be more likely to keep talking.
“It helps to sometimes just ask them point blank,” Cullen said. “But
other times, it’s better to ease into it. That’s why medicine is an art.”
Cullen has found that the relationships that he’s established during
the course of his 25-year tenure in his community have also helped.
“It works both ways, too. People are much more likely to tell me what’s
going on because they know I’m less likely to judge them,” he said. “But if
they are not being truthful, I can call them on it because I’ve known them” for
Fagerlin also cited the usefulness of tools and strategies like the Teach Back
method, which can help a clinician gauge how well a patient truly
understands their situation, and the recommendations from their provider.
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