Patient Deception of Doctors
IndustryView | 2014
When patients don’t reveal the whole truth about their health to doctors, the consequences can be serious—even when it’s regarding details that seem insignificant or irrelevant. Unnecessary and costly tests may be performed. Patients can be misdiagnosed and prescribed treatment that worsens an existing condition. So, how can physicians recognize when they aren’t being told the whole story, and encourage patients to feel comfortable opening up?
We conducted an online survey of 3,075 American patients and shared the results with industry experts to discover why, how and about what patients knowingly deceive their doctors. Here’s what we found.
Our survey revealed that half of patients have withheld information from their doctors. One-quarter of patients admitted to giving incorrect information or omitting information about their health at least “sometimes.” Another one-quarter of patients “rarely” withhold information, and half say they have “never” been deliberately misleading during a medical office visit.
But in fact, the real number of patients who deceive doctors may be higher than 50 percent. According to Dr. Leana Wen, emergency physician at George Washington University and author of “When Doctors Don’t Listen,” most patients don’t intend to give doctors inaccurate information. Instead, patients often leave out previously diagnosed conditions or symptoms they don’t think are related to the reason for their visit.
“[Patients] tell us ... their ‘mental shortcuts,’” he says, “rather than explaining their symptoms.”
For example, Dr. Liu describes how a patient may come in saying they have the flu instead of describing what they’re experiencing. He suggests that doctors take a step back and ask additional questions—such as asking patients to describe what they’re feeling—in order to keep an open mind and avoid being misled.
Since so many patients are either knowingly or unknowingly dishonest, we were interested in discovering what types of health information patients feel uncomfortable discussing openly with their doctor. We found that among patients who admitted to withholding information, drug, alcohol and tobacco use was the most common area in which patients were dishonest.
A 2014 study by the CDC revealed that only one in six adults discusses their drinking habits with a healthcare professional—a sobering statistic, considering that 38 million Americans are reported to have a drinking problem. They recommend that doctors screen patients for alcohol dependence at checkups and counsel patients on the health risks associated with excessive alcohol consumption.
Eating habits and diet was the next most common topic patients were dishonest about, at 31 percent. Fewer patients (24 percent) were withholding information about their sexual activity and preferences, and less than 20 percent failed to disclose current medications.
Dr. Liu notes that getting to the truth on any topic can often be a difficult undertaking.
“How to get the right information [lies in] how the doctor phrases the question,” he explains.
This entails asking the right follow-up questions, such as asking a patient to describe how many drinks they consider to be “not much” or asking what they ate that day. And responding with the right body language—smiling, being conscious of tone and making eye contact—can all make a difference in how patients respond to questions about sensitive topics.
Another topic that patients may avoid addressing is their use of alternative medicine, such as acupuncture and herbal supplements. Dr. Wen points out that two-thirds of patients participate in alternative medicine and may be hesitant to inform their doctors about these practices, fearing that they may not be accepted.
Out of the patients who admitted that they had deceived a doctor, almost 40 percent did so by minimizing. Psychologists define minimizing as the act of rationalizing or lessening the importance of their symptoms, habits or current and past conditions.
The tendency of patients to minimize or downplay the truth is a lesson many doctors know well. If a patient says he/she has two drinks a day, it’s often a good idea to double that and assume they have four.
Twenty-six percent deceived via exaggeration, and slightly fewer—23 percent—refused to disclose information at all. When a patient won’t discuss a topic, Dr. Wen recommends being mindful of nonverbal cues. A patient who smells like cigarette smoke, for instance, is unlikely to have quit smoking.
Fabricating information was the least common method of deception, with 12 percent of patients claiming to have done so.
Among patients who responded that they had withheld information, 14 percent did so in order to avoid feeling embarrassed or being lectured by their doctor.
Lecturing or issuing direct orders to patients doesn’t only encourage them to lie, but has also proven ineffective. A 2010 study in the American Journal of Preventative Medicine found that scolding, judging or confronting patients about their weight was, unsurprisingly, much less effective than discussing the problem and collaborating to find a solution. Both Dr. Liu and Dr. Wen agreed that having an open-minded approach and non-judgmental tone can be beneficial in helping patients overcome a fear of being lectured.
Eleven percent of patients were seeking to protect their privacy—a worry that may be alleviated by mentioning privacy laws such as HIPAA. And 5 percent of patients were concerned with avoiding the cost or inconvenience of treatment.
The cost of treatment can be a concerning factor for some patients who cannot afford their medication, yet they may be embarrassed to admit this to their physician. Patients may also be reluctant to disclose that they cannot easily or affordably access tools for healthier living, such as healthy foods or a place to exercise. Dr. Liu points out that patients usually respect their doctors, and are hesitant to admit that there are barriers between them and healthier habits.
Working towards having a trusting relationship with patients, however, is one strategy for helping patients feel comfortable disclosing personal information. In the next section, we’ll explore other strategies that doctors can use to assuage common patient concerns.
The results on methods doctors could use to get patients to be more forthcoming were mixed. Forty-three percent of patients said there was nothing a doctor could do to get them to open up. But among those who could be persuaded, 35 percent of patients would be less likely to withhold information from a doctor if they were assured of confidentiality.
Although most patients are aware that doctor-patient confidentiality laws like HIPAA exist, patients may be unsure what they apply to and under what circumstances they can be broken. Laws governing confidentiality in the medical field differ from state to state, so understanding how privacy laws apply to your location and explaining what is and isn’t covered may help ease confidentiality worries.
Twenty-three percent expressed a preference for an assurance that the doctor wouldn’t judge them. Dr. Wen suggests that doctors share their own experiences in order to encourage patients to open up about personal information. Sharing information about personal struggles with quitting smoking or handling a loved one’s illness can help patients to relate and feel less like their doctor is judging them.
Additionally, becoming aware of your own inherent biases and how to turn them off, notes Dr. Liu, can help make a patient more comfortable.
“[For example,] if a doctor appears [unwilling] to hear a patient on why he or she drinks alcohol at unhealthy levels, it is unlikely this person will answer a doctor honestly,” he says.
Nineteen percent of patients would be most convinced to be forthright if doctors explained the consequences of misinforming or misleading health professionals, which include misdiagnosis and harmful drug interactions. Eighteen percent would be encouraged to be honest if the doctor reassured them that they could help, and only 6 percent wanted their doctor to gently confront them about a perceived lie.
These results demonstrate that there are a myriad of ways in which patients can intentionally and unintentionally hide critical information from doctors and other healthcare professionals. The suggestions cited above, which include asking informed follow-up questions, maintaining eye contact, avoiding lecturing and clearly explaining confidentiality laws, can go a long way towards improving communication and trust with patients
Although these methods may encourage some patients to be forthcoming, others may still be reluctant. Dr. Liu acknowledges that, in some situations, there isn’t anything a doctor can do to draw the truth out of a patient who is unwilling to open up. But what doctors can do is take the first steps to establishing a trusting relationship where patients feel comfortable sharing their personal information.
To further discuss this report or obtain access to any of the charts above, feel free to contact me at firstname.lastname@example.org.