Lies Your Patients Tell You

Have you ever suspected that a patient wasn’t telling you something important, something that might impact their care?

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 half-truths
 

Here’s what your patients may not be telling you, according to the researchers:

  • 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 medication

    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 it’s unhealthy. 
  • “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 implications

    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 taking.

    “We need to make sure that patients understand what the consequences are,” said Fagerlin.

    Using discernment and building trust

    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 gut.

    “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 continued.

    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 so long.

    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.

    RELATED: Building Patient Trust with Effective Doctor–Patient Communication 

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