Do doctors know when their patient is lying?

Are your patients lying to you? Sadly, some of them may be. According to a survey from TermLife2Go, nearly 25% of patients lie to their doctors about various aspects of their health. This is bad news not only for doctor-patient relationships—which should be founded on honesty and open communications, but for optimal patient care as well.

The survey, which included 500 people, uncovered some interesting tidbits about how often and why patients may lie to their physicians. The most frequent lie patients engaged in was about their smoking habits. Indeed, a full 46% of respondents reported that they had engaged in such behavior. This was followed by 43% who reported lying about exercising (or not), 38% about alcohol consumption, and 29% about sexual partners.

In further breaking down the data, TermLife2Go pollsters found interesting differences between the sexes. More men lied to doctors about their alcohol consumption compared with women (50% vs 32%, respectively), but women were more likely to lie about their sexual partners (33% vs 21%).

For 75% of “liars,” their primary motivation was to avoid embarrassment, but there were other reasons. For instance, 31% of respondents reported that they lied to their doctors to avoid discrimination (mostly female [80%]), while 22% did so because they didn’t think their doctors would take them seriously if they told the truth.

The silver lining of these results was that most people (77%) reported that they are honest with their doctors. But, being honest came at a price. Nearly 50% reported that telling the truth isn’t always comfortable. Indeed, 50% of respondents reported feeling uncomfortable talking with their physicians about their sexual activities.

But, a good number of respondents (34%) said they were comfortable talking with their doctors about anything.

More lying…

In a larger survey published in JAMA Network Open, other researchers found similar results. They combined two survey samples totaling 4,510 respondents. The first sample included 2,011 US adult participants of Amazon’s Mechanical Turk (MTurk) marketplace (internet users who took part in tasks such as surveys in exchange for monetary compensation; mean age: 36 years); the second sample included 2,499 older US adult users (mean age: 61 years) from Survey Sampling International (SSI), a demographically diverse web panel.

The researchers broke down their results on patient “nondisclosure” even further than the TermLife2Go experts, and found the following:

• 7% and 31.4% of MTurk and SSI respondents, respectively, avoided telling physicians pertinent information because they disagreed with their physicians’ recommendations;
• 8% and 24.3% did not understand their physicians’ instructions;
• 5% and 20.3% did not report an unhealthy diet;
• 5% and 21.6% did not report not taking prescription medications as instructed;
• 2% and 21.6% did not report not exercising;
• 5% and 10.4% deliberately did not mention taking certain medications; and
• 9% and 8.8% did not report taking someone else’s prescription medication

They also found that the five most common reasons for respondents to not disclose information to their doctors were as follows:

• 8% and 64.1% of MTurk and SSI respondents, respectively, did so because they didn’t want to be judged or lectured;
• 7% and 61.1% did not want to hear how harmful their behaviors are;
• 9% and 49.9% were embarrassed;
• 8% and 38.1% did not want their doctors to think they were difficult patients; and
• 2% and 35.9% did not want to take up more of the doctors’ time

Beyond these findings, it may be surprising to know that respondents also reported not disclosing important information because they didn’t think it mattered (38.6% and 32.9%, respectively), they didn’t want their doctor to think they were stupid (37.6% and 30.6%), and they didn’t want the information on their medical records (34.5% and 30.6%).

“The results of this research reveal that most patients have withheld medically relevant information from their clinician at least once, especially regarding disagreement with clinician recommendations and failure to understand clinician’s instructions, and that the most commonly reported reasons for doing so were that patients did not want to be negatively judged by their clinician, did not want to hear how harmful the behavior in question was, or were embarrassed,” noted the authors, led by Andrea Gurmankin Levy, PhD, MBe, professor and program coordinator, Psychology, Department of Social Sciences, Middlesex Community College, Middletown, CT.

“These findings indicate that clinicians at times do not receive accurate, relevant information from patients, which may affect clinicians’ diagnoses and recommendations as well as patient care,” they added.

And disturbingly, Dr. Levy and colleagues also found that women, younger patients, and those who had worse self-rated health were significantly more likely to have ever not shared at least one of the seven types of information with their doctor

“Survey respondents who were sicker (ie, worse self-reported health, had chronic conditions) were slightly, but significantly, more likely to withhold information from their clinician, indicating that the very patients who are in greatest need of high-quality healthcare because of the complexity of their health may be more likely to compromise their care by withholding important information from their clinician,” they noted.

Dr. Levy and fellow researchers concluded that their results are consistent with previous findings, and that nondisclosure of information is a significant and ongoing problem. They also stressed that their study was the first to focus on the common reasons why patients may lie to their doctors.

“Our study highlights that nondisclosure can occur for even relatively mundane interactions with a clinician (eg, not understanding their instructions) despite the potential consequences of these nondisclosures,” they wrote.

Ultimately, patients lying to their physicians may contribute significantly to an inability to achieve optimal patient care.

“The results of this research highlight an important and concerning reality in healthcare. If patients are withholding information from clinicians as frequently as this research suggests, then clinicians are routinely not receiving the information that they need to provide high-quality care to patients, especially sicker patients. The clinician-patient relationship requires honest and open communication between both parties to maximize the therapeutic benefit and avoid potential harms. Future research should test interventions aiming to increase the trust and communication between patients and their clinicians as well as patients’ comfort with disclosing information to their clinicians,” concluded Dr. Levy and colleagues.

To combat patient nondisclosure, clinicians should strive to create a judgment-free, open environment, where their patients feel safe enough to be open and honest. Watch your patients carefully. Don’t just listen to their words; pay attention to their body language. And for more tips, see MDLinx’s article, “5 ways to tell when your patient is lying to you.”  

This study was funded by the University of Michigan Division of General Medicine.