There's an open secret in medicine:
Patients lie. They lie about how much they smoke
and whether they're taking their medicine. They understate how much
they drink and overstate how much they exercise. They feign symptoms to
get appointments quicker and ask doctors to hide the truth from
insurance companies.
"Doctors have a rule of thumb. Whatever the
patient says they're drinking, multiply it by three," said Dr. Bruce
Rowe, a family doctor in suburban Milwaukee. "If they say two drinks a
day, assume they have six."
Hippocrates, the father of medicine, is said
to have warned his students around 400 B.C. that patients often
dissemble when they say they've taken their medicine. TV's fictional
Dr. Gregory House repeats the same message to his crack team:
"Everybody lies."
But lying can lead to expensive diagnostic
procedures and unneeded referrals to specialists. It also can have
disastrous results.
"I definitely learned my lesson. I could have
ended up in a coma," said Michael Levine, a 28-year-old financial
adviser in Los Angeles, who lied to a specialist he saw for a wrist
injury. Misguided pride, he said, kept him from mentioning the Xanax he
was taking for anxiety. He didn't think the doctor needed to know.
"He wasn't my regular doctor. He was treating my wrist," Levine explained.
The doctor prescribed the pain reliever
Vicodin and Levine took it on top of Xanax. The next few days vanished
in a cloud of grogginess. Levine slept through ringing phones and
alarms and woke up exhausted. His wrist pain was easing, but he could
barely function. Eventually, he stopped the Vicodin, returned to the
doctor and, under questioning, confessed.
"The doctor said, 'Why didn't you tell me? I
never would have prescribed you that,'" said Levine, who now realizes
how easily he could have overdosed and died. "For the future, I will
always 'fess up."
Why do patients lie? The examination room itself is an environment that discourages honesty, said Los Angeles psychiatrist
Dr. Charles Sophy.
"You're naked in a gown and you have a guy
standing there clothed, with a coat on and there's all sorts of things
in his pocket. And you're sitting there, basically naked ... that makes
it hard to come clean," Sophy said. On top of that, the doctor may be
rushed.
Researchers say patients often lie to save
face. They want to be "good patients" in their doctors' eyes. But
that's a misguided and risky practice. For example, a woman who doesn't
want to admit she smokes and then is prescribed birth control pills is
at greater risk for blood clots.
Some researchers estimate more than half of
patients tell their doctors they're taking their medicine exactly as
prescribed when they're not. In reality, they don't like the side
effects, can't afford the pills or didn't understand the instructions.
A study by researchers at Johns Hopkins School
of Medicine found a big gap between what patients said and what they
did. Researchers looked at how patients with breathing problems used an
inhaler equipped with a device that recorded the date and time of use
and compared that with what the patients said.
Seventy-three percent of patients reported
using the inhaler on average three times a day, but only 15 percent
actually were using it that often. And 14 percent apparently
deliberately emptied their inhalers before their appointments to make
it look as if they were good patients.
Some doctors are seeking approaches that
encourage more honesty. Dr. Zach Rosen, medical director of New York's
Montefiore Family Health Center, asks his patients a series of
questions to determine whether they're taking their medicine.
"I ask, 'What medications are you taking?' At
first, I just want the names," he said. "They say, 'I'm taking X, Y or
Z.' Then I'll say, 'That's great. How often are you taking that
medication?' ... Then I'll say, 'Are you experiencing any problem in
taking your medications?'"
Asking several questions takes more time. But
the approach elicits better, more honest responses than a single
question, Rosen believes.
Doctors also should avoid phrases that sound
judgmental, said Nate Rickles, an assistant professor of pharmacy at
Northeastern University. There's a big difference between "Why aren't
you taking the medication as prescribed?" and "A number of my patients
don't take their medication as prescribed and they do it for a variety
of reasons. What do you think might be going on with you?"
When alcoholics seek detox treatment from Dr.
Akikur Mohammad, an addiction specialist at the University of Southern
California School of Medicine, they must tell him exactly how much
they've been drinking so he can give them the right dose of medication
to treat withdrawal.
"I tell them, 'You can lie to your friend, you
can lie to your family members, but you came here for help and your
report will determine the treatment plan. If I undermedicate you, you
may have seizures and die,'" Mohammad said. Despite the warnings,
patients still sometimes mislead him, he said.
Cyndi Smith, a 45-year-old Weight Watchers
leader in suburban Chicago, admits her own lying past when it came to
questions about her exercise and eating habits. She says she lied
because she was fooling herself.
"You convince yourself of certain things and
it becomes true, when in reality it's not," she said. If her doctor had
questioned her more thoroughly, she says she might have told the truth.
"I think doctors could be a little more point-blank," she said. "And we need to be a little more honest."