45% of WebMD Readers Don't Tell Their Doctors the (Whole) Truth
Sept. 21, 2004 -- Do you lie to your doctor? There's about a 50-50 chance you do, a WebMD survey shows.
See what the experts say in part 2 of our three-part series.
What the Experts Say
WebMD discussed the survey results with three experts:
- Ethicist Arthur Caplan, PhD, chair of the department of medical ethics and director of the Center for Bioethics at the University of Pennsylvania, Philadelphia.
- Psychiatrist and ethicist Robert Klitzman, MD, who is assistant clinical professor and co-director of the Center for Bioethics at Columbia University, in New York. He's an expert in issues of privacy and disclosure of medical information. Among other titles, Klitzman is author of Mortal Secrets: Truth and Lies in the Age of AIDS.
- David L. Roberts, MD, who is associate professor of internal medicine at Emory University, in Atlanta, and medical director of the Emory executive health program.
WebMD: Is there ever a good reason to lie to your doctor?
Caplan: "There are reasons why it might make sense to lie to your doctor, even though it may hurt your medical care. The model in our mind of who looks at our records is outmoded. We really don't have as much privacy as we like to believe we do, and patients tend to know that.
"If your child has a psychiatric condition for example, you might be penalized for talking about that with your doctor if your employer finds out. That is a high bill that your employer might want to avoid paying.
"If there is something that can be done therapeutically, you need to tell your doctor about your problem. Alcohol or drug use you may be embarrassed about, you may not want to fess up, but you may want to tell the truth about something so important to your health. If you are having an affair and get a venereal disease, yes, it's hard to tell your doctor -- but it is up to you to tell, because there is a treatment and you'll need it. So will your partner.
"If on the other hand you have a pre-existing condition and there is nothing medicine can do -- say you've got the Huntington's gene, or the gene for early-onset breast cancer -- if there is no good my doctor can do me and only harm can befall me, why tell? This is not lying but withholding the truth."
Roberts: "Are there good reasons to lie to doctor? No. Reasonable reasons? Not really. It is silly to pay a doctor for an opinion and have him base that opinion on less than 100% of the truth."
Klitzman: "Yes, particularly with genetic tests that show a high risk of disease. The doctor may not say, 'Whatever you tell me won't go in the record.' But around genetic diseases, or with self-insured businesses, people may not want their employer to know things. This is something you can say to your doctor.
"Now if it is something like, 'I am beating my son' -- that the doctor must report. But if it is a legitimate concern, the doctor may say that if it is not medically relevant, it needn't go into the record. A lot of doctors don't think and put everything in the chart. Yet maybe a lot of things don't belong in a chart."
WebMD: Why do people lie to their doctors?
Klitzman: "It is specifically about taboo areas. One is adherence to treatment. Lots of patients don't do what the doctor says, but are afraid the doctor will get mad if they say so.
"Another is substance abuse. We were taught to double what the patient says. So if a patient says, 'I drink only two glasses of wine a night,' the professors would say that means four. If they say they take cocaine twice a week, that means four times a week.
"And another taboo is the area of sexual behavior, everything from homosexuality to extramarital relationships. The doctor will say, 'Are you practicing safer sex?' and they will say yes when they are not. They aren't saying, 'I usually do, but there was this time we had a few beers and we forgot the condom,' or, 'We got carried away the other night.' It's just a taboo area."
Caplan: "If people are honest about their conditions they may fear risking loss of job or insurance. They also may lie to ensure access to medical services. And they may lie so that they can get insurance reimbursement for a condition. They also lie out of humiliation or to protect a spouse.
"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.
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"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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