Commentary
by Darrell R. Over, MD, MSc, FAAFP
UAMS (South Central) Family Medicine Residency, Pine Bluff
Your Patient May Be Lying To You – Here is Why
Fans of the medical drama “House,
MD” may recall the soliloquy by the
title character, Dr. Gregory House, portrayed
by actor Hugh Laurie: “It’s a basic
truth of the human condition that everybody
lies. The only variable is about what.
I don’t ask why patients lie. I just assume
they all do. Truth begins in lies. I’ve found
that when you want to know the truth about
somebody that someone is probably the last
person you should ask. Reality is almost always
wrong. Everybody lies.”
This view of patients was typical of the
cynical, misanthropic, and narcissistic Dr.
House personality. Research, however, suggests
that this assertion is much closer to
the truth than many physicians would like to
believe.
A survey 1 of two patient cohorts comprising
4,510 total respondents provides perspective
of the scope of this issue. The two
cohorts were classified as MTurk (n=2011;
mean age 36 years; 84% white; 60% female)
and SSI (n=2499; mean age 61 years; 79%
white; 51% female). Among both cohorts,
more than 40% had completed at least a
bachelor’s degree. Substantial agreement
was discovered in answers to questions for
ever having concealed at least one of seven
types of clinically relevant information
[MTurk vs SSI]: disagreeing with physician’s
recommendation (46% vs 31.4%); not understanding
physician’s instructions (32%
vs 24%); unhealthy diet (25% vs 20%); prescription
medication noncompliance (23%
vs 18%); irregular exercise (22% vs 22%);
purposefully omitting a medication (16% vs
10%); or taking another’s prescription medication
(14% vs 9%). Overall, about 81% of
the MTurk cohort and 61% of the SSI cohort
admitted to concealing at least one type of
information. These findings are consistent
with a 1994 study revealing that about 84%
of patients concealed the truth and approximately
one-third of patients lied to their
physician. 2
A survey of over 1200 Medicare Advantage-insured
patients revealed that 47%
of patients either “sometimes” or “often”
lied to their physician. Interestingly, women
were 16% less likely to be truthful with
a male physician whereas men were 30%
more likely to be truthful with a female physician.
3 Another insurance company survey
of 500 patients demonstrated that 46% lied
about tobacco smoking; 43% lied about exercise
habits; 38% lied about alcohol consumption,
and 28% lied about sexual partners.
Men lied more than women about alcohol
consumption (50% vs 32%) and women
more than men about sex (33% vs 21%).
Patients less than 35 years of age lied more
about tobacco smoking whereas patients
over 35 years age lied more about exercise. 4
The danger for patients lying to us range
from failure for timely diagnosis, a misdiagnosis,
or medical error in therapy. Given
these risks, why do patients lie to their physician?
Most patients do not realize that by
lying they may cause us to mistakenly harm
them by our action or inaction. In the above
studies, recurring reasons given for lying included
fear of embarrassment, concern for
being negatively judged, and to avoid lectures
about unhealthy behaviors.
We are unable to diagnose, treat, or
advise our patients effectively unless they
share information openly and honestly with
us. The reasons for lying noted above suggest
that how we communicate in certain
situations may cause patients to be hesitant
to reveal clinically relevant information. By
clearly communicating that we have no other
motive than to help and that we have only
their best interests at heart – and while comporting
a caring, non-judgmental demeanor
– we can alleviate the major obstacles preventing
patients from dealing with us honestly
and improve the care we provide.
References
1. Levy AG, Scherer AM, Zikmund-Fisher
BJ, et al. Prevalence and factors associated
with patient nondisclosure of medically
relevant information to clinicians.
JAMA Network Open. 2018;1(7):e185293.
doi:10.1001/jamanetworkopen.2018.5293
2. Burgoon M, Callister M, Hunsaker FG. Patients
who deceive: an empirical investigation
of patient-physician communication.
J Language Psychol. 1994(Dec);
3. The lies patients and doctors tell: a new
patient-doctor communication study.
August 2018. https://www.medicareadvantage.com/patient-doctor-lies-survey.
Accessed May 1, 2020.
4. Enabit A. We asked 500 people, “Do you
lie to your doctor?” Feb 24, 2020. https://
termlife2go.com/lying-to-your-doctor/
Accessed May 1, 2020.
“In the above studies,
recurring reasons given
for lying included fear of
embarrassment, concern
for being negatively judged,
and to avoid lectures about
unhealthy behaviors.”
52 • The Journal of the Arkansas Medical Society www.ArkMed.org