Health: What the Experts Say (cont.)
"And then there is the issue of lying in order to get seen faster. Some people say they have worse symptoms than they do. I have heard that. When it's hard to get a doctor's attention, they will lie in order to get in there. It is a patient version of 'resource allocation.'"
Roberts: "Probably the same number of people lie to their spouses or significant others as lie to their doctor -- and probably about same things. So I wonder whether people lie a lot to begin with.
"A lot of people, if they are concerned or embarrassed about drinking or sexual activity, may not share this with anyone else: not their doctor; not their partner; not their parents; not their friends. These are secrets people like to keep."
WebMD: Does lying to your doctor weaken the doctor/patient relationship?
Caplan: "In this day and age, not much. The Norman Rockwell-primary-care-provider model -- the caring person talking to people he's known all their lives about their health -- it may still exist, but it is not as common as we might like to think.
"Medicine has become more and more bureaucratized and delivered by teams and institutions, not individual practitioners. You are so pressed for time. The doctor is trying desperately to get key facts out of a patient in as little time as possible. But if the doctor moves, if patients move as much as they usually do these days, they don't have even a minimal relationship. So I will say, sadly, that lying does not affect this kind of relationship that much."
Klitzman: "Your survey is important in the debate over managed care. With the growth of managed care, people now see different doctors, the doctors come and go, or companies switch plans. What that means is now you often have a new doctor.
"And part of the physician-patient relationship depends on trust. That is something built up over time. You tell a little this time, and then next time you tell a little more. But now, many people see a doctor for the first time every time.
"So there is arguably less trust and less forthcomingness. There is less trust and less discussion about taboo subjects. Much of this information is necessary to diagnose treatable diseases."
WebMD: Should doctors help patients hide the truth?
Roberts: "Doctors can't always promise to conceal the truth. I can say lets talk about it, but I can't promise it won't go into the record. We won't falsify our records. I won't say a patient doesn't smoke when he does. If you're trying to hide something from your insurance company, or trying to keep smoking or drug use out of your insurance history or record, that is a shame or a problem or both.
"I don't think you should lie on a medical record. If you lie to your physician, and that becomes part of your insurance record, you are subject to fraud. It is better not to lie, period. You may say this is something I don't want to talk about. But for legal reasons, I don't think patients should lie on insurance records. Worrying about increased premiums is not a justification for fraud.
"If there is something you are doing you can't share with someone, maybe you shouldn't be doing it. If there is something you can't even tell your doctor in privacy, you should think about whether this is an appropriate behavior or decision. If you are drinking so much you can't even tell your doctor how much, this should hit you upside the head as a warning sign that something is very, very wrong with your health."
Klitzman: "Patients should realize that doctors want to help them. It is alright to ask them, 'Say, can I say something to you that you won't put in the chart?' I wouldn't say to a doctor, 'Don't put this in my record,' but I would raise it as a question."
WebMD: How realistic is it for patients to fear their doctors' judgment? How can doctors help patients tell the truth?
Caplan: "The doctor may not be as much inclined to judgment as many people think. Doctors' practice of medicine is better than patients give them credit for.
"Telling a doctor you are HIV positive or telling a doctor you have some kind of mental illness or are incontinent can be embarrassing. But medicine has got better about being able to deal with these things without judgment."
Klitzman: "Largely, doctors are there to help. The notion that my doctor is going to be mad at me is human. I want him to like me. He gave me this medicine and I never even filled the prescription, so I'll lie about it. People want to be on the good side of the doctor, but that is not as important as getting the best care they can get.
"A good [doctor] can elicit things from a patient. It is important that doctors try to build trust with patients. So a good doctor will say, 'Did you smoke any pot or whatever?' in a casual, nonjudgmental way. You can say, 'A lot of us feel we drink more than we should, how about you?' There are things doctors can do that we need to encourage."
See what the experts say in part 1 and 3 of our three-part series.
Published Sept. 21, 2004.
SOURCES: Editorial Survey on WebMD Health, "Why Do You Lie to Your Doctor?" Sept. 3, 2004. Arthur Caplan, PhD, chair, department of medical ethics; and director, Center for Bioethics, University of Pennsylvania, Philadelphia. Robert Klitzman, MD, assistant clinical professor; and co-director, Center for Bioethics, Columbia University, New York; and author, Mortal Secrets: Truth and Lies in the Age of AIDS, Johns Hopkins University Press, 2003. David L. Roberts, MD, associate professor, internal medicine, Emory University, Atlanta; and medical director, Emory executive health program. WebMD message boards.
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Last Editorial Review: 5/10/2005