Fortunately most patients are honest. They mean what they say, and they realize that ultimately it is in their own best interests to be truthful about their health issues. However, it is a stark reality that many patients lie to health care professionals.
According to a WebMD survey about patients lying to doctors, out of nearly 1,500 respondents, 45% admitted they had either lied (13%) or “stretched the truth” (32%).
It is likely that an even larger percentage of jail and prison inmates lie to health care providers.
Patients are untruthful for different reasons.
People everywhere typically want to present themselves in a positive light. They do not want to be lectured or shamed.
For example, patients may stretch the truth about lifestyle issues such as diet, exercise, smoking, drinking, and illicit drug use. They may exaggerate their adherence to or response from prescribed medications.
Patients also lie because they want something.
Some want controlled substances, and others want work excuses or disability. Patients may understate symptoms or omit significant medical history to improve their chances of obtaining life or disability insurance. Likewise, some may exaggerate symptoms to help ensure that their health insurance plan will cover a diagnostic or treatment intervention.
And yet others lie because they do not trust their doctors.
How can health care professionals best approach this challenging issue?
1. Try not to be judgmental. Treating patients with respect and not passing moral judgment on them will not only improve your therapeutic alliance, but it may make them feel more at ease and ultimately less likely to lie or exaggerate.
2. Develop a healthy skepticism. In your interactions with patients, always consider what is at stake for them. What might they lose or gain from their encounter with the health care system? Their pride, their disability payments, a medication they want? These will be the most likely incentives for deceitfulness. Please keep in mind that it is both possible and desirable to be skeptical without being cynical.
3. Do your homework in high stakes situations. In situations where a particular requested or indicated intervention may cause harm, spend extra time reviewing the medical record and any other available documents. In the prison system, when I am aware that a particular new patient is drug-seeking or otherwise wanting something significant, then I will not only review the record thoroughly before the appointment but also review records in the computer system such as the presentence investigation report (PSI). When the appointment begins, I already know far more about the person than he expects me to know. I conduct a normal interview, and I look for inconsistencies. Sometimes there are none, and I trust the patient more. In other encounters there are numerous inconsistencies. In a seemingly puzzled manner, I point them out later in the interview. The patient eventually understands that I am very detail-oriented, I take my job seriously, and I am not going to be an easy target. It is not practical or necessary to approach every patient visit in this manner. It is very time-consuming, and our primary role is to provide health care, not to be detectives. But, in select cases, doing extra homework up front can save time and trouble later.
4. Obtain collateral information if possible. Will the patient allow you to obtain copies of their medical records from other hospitals or clinics? Especially in the high stakes situations noted above, I ask the patient about such records for a couple of reasons. First, if they exist, they may be helpful in the patient’s care. Second, if the patient agrees to allow me to obtain such records, and if such records exist, then I am more likely to trust the patient. If the requested records do not exist, or if the patient adamantly does not want me to be able to access outside records, then I will be more skeptical.
Do you have other strategies that you have found helpful in dealing with these situations? Please feel free to share them.
Related posts:
- How correctional health care professionals can advocate for their patients
- Risk management tips for correctional health care professionals
- Patients Should Be Allowed Online Access to Their Own Health Records
- Multidisciplinary teams enhance prison mental health care
- Seven Tips for Providing Health Care to Inmates In Any Setting
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