The Fine Art of Lying to Your Medical Provider
Not everyone is honest, at least 100% of the time. Whether it is human nature to stretch the truth, exaggerate, or just downright lie is up for debate. In the medical world, it happens all of the time.
"What was his temperature this morning?" "Oh, it was 103.6. " "What kind of thermometer did you use?" "My thermometer is broken, so I just felt his forehead and "guessed" that it was about 103.6."
Now, I have felt hot and feverish people throughout my entire medical career, and there is no way that I could guess a fever to that level of accuracy.
Parents are so afraid that their child's fever will be normal when they finally get to the office that they often withhold giving acetaminophen or ibuprofen so that I will take the fever more seriously. The child unnecessarily suffers for hours by this decision. While fever is absolutely harmless, the profound discomfort associated with illness should be promptly addressed. At this stage in my career, a high fever does not impress me. Basically, unless I see smoke or flames coming out of some body orifice, I don't really care how high a fever is. Other symptoms and physical findings are much more important.
Did you complete all of the medications I gave you? Yes, I took them all, but the pharmacist must have given me too many pills. They lasted 14 days instead of ten. Guess what? The pharmacist probably counted them out corrected; you just "missed" a few."
I often have patients under my care bring the medications they are taking with them to every visit. Not only can I make sure that the pharmacist did NOT make a mistake (It happens), but I can check on compliancy. For instance, if a person is supposed to take two pills a day for a month (sixty pills) and I see them in two weeks, they should have about half a bottle left. I am not shy about dumping out their pills on a piece of paper and counting them out. If I find about 20-25 in there, I am going to need an explanation. As basic as this advice sounds, pills are totally ineffective from inside the bottle.
Are you staying on your diet? Yes, I am eating less than 800 calories a day. So, what do you attribute to your 12 pound weight gain since your last visit a month ago? No, I don't think you are retaining that much water. Unless you have a camel hump on your back, there needs to be another reason. I often ask patients to write down EVERYTHING they eat for a week so that I can review their diet. When I see "one Krispy Kreme donut" written down, I know they are lying. NO ONE can just eat one Krispy Kreme. Who are they trying to fool? That's like writing down one potato chip. Unless it was stale or had a fly sitting on it, that is lie, too.
Lying about salt use, caloric intake, or the amount of exercise is universal. I could easily lie about that myself. I love to eat. I love salt. I hate to exercise. When my own doctor asked those questions, I am tempted to stretch the truth, but why? He will know I am lying. I will know I am lying, so I just try to be honest.
I was listening to Jeff Foxworthy the other day talking about his dentist visit:
Accurate information about a person's sexual history is very difficult to obtain, especially from teenagers. Teenagers often lie as the first line of defense. They even lie about stuff that is not important. An accurate sexual history IS very important in order for your medical provider to assess health risks.
I stopped asking if a person was "sexually-active" since that statement can be misunderstood. The word "active" is vague and can mean different things to different people. I once had a teenager respond to that question by saying, "What to you mean? Do I like, move around a lot during sex?" So now, I simply ask teenagers if they have EVER had sex...in any form. I don't want any of those Bill Clinton answers. When a teenager tells me they have never had sex and I find out they are three months pregnant, we need to have a long talk. Unless a star rose in the East, or someone is a very heavy sleeper, that someone is not telling the truth.
People always lie about the number of sexual partners. Some men are proud of their life score, so I always cut that exaggerated number in half. On another sexual issue, I once read that said that "Ninety percent of all men masturbate. The other ten percent lie." Whether someone masturbates or not, is really not an important sexual question. If your doctor asked you about it, he is just "weird," so it's okay to lie. If you are asked if you masturbate, just proudly say, "You bet! Every chance that I get. I was doing just before you came in."
Women tend count only significant sexual relationships; one-night stands don't make the list. They are probably afraid to tell me that they have had some God-awful number of partners for fear that I will think poorly of them. They always throw out a small number to throw me off track. Besides, what if someone read their chart? People may be whispering and grinning at them the next time the come in. For sensitive information like this, I tend not to write this stuff down in their chart.
I once took care of a 75 year old mother of a PA colleague. She was concerned that I would call her son and share her private medical history so she decided to test me. She told me that she was thinking about leaving her husband and having an affair with the bus driver. We discussed this at great detail. When that MIS-information never made it to her son (I would NEVER reveal confidential information like this), she eventually told me the affair story was just "a lie." She was just testing my level of confidentiality. Rather than be amused by this act, I dismissed her as a patient. Personally, I think she was hitting on that bus driver.
Related Topics: Technorati Tags: medicine, honesty, health and wellness
"What was his temperature this morning?" "Oh, it was 103.6. " "What kind of thermometer did you use?" "My thermometer is broken, so I just felt his forehead and "guessed" that it was about 103.6."
Now, I have felt hot and feverish people throughout my entire medical career, and there is no way that I could guess a fever to that level of accuracy.
Parents are so afraid that their child's fever will be normal when they finally get to the office that they often withhold giving acetaminophen or ibuprofen so that I will take the fever more seriously. The child unnecessarily suffers for hours by this decision. While fever is absolutely harmless, the profound discomfort associated with illness should be promptly addressed. At this stage in my career, a high fever does not impress me. Basically, unless I see smoke or flames coming out of some body orifice, I don't really care how high a fever is. Other symptoms and physical findings are much more important.
Did you complete all of the medications I gave you? Yes, I took them all, but the pharmacist must have given me too many pills. They lasted 14 days instead of ten. Guess what? The pharmacist probably counted them out corrected; you just "missed" a few."
I often have patients under my care bring the medications they are taking with them to every visit. Not only can I make sure that the pharmacist did NOT make a mistake (It happens), but I can check on compliancy. For instance, if a person is supposed to take two pills a day for a month (sixty pills) and I see them in two weeks, they should have about half a bottle left. I am not shy about dumping out their pills on a piece of paper and counting them out. If I find about 20-25 in there, I am going to need an explanation. As basic as this advice sounds, pills are totally ineffective from inside the bottle.
Are you staying on your diet? Yes, I am eating less than 800 calories a day. So, what do you attribute to your 12 pound weight gain since your last visit a month ago? No, I don't think you are retaining that much water. Unless you have a camel hump on your back, there needs to be another reason. I often ask patients to write down EVERYTHING they eat for a week so that I can review their diet. When I see "one Krispy Kreme donut" written down, I know they are lying. NO ONE can just eat one Krispy Kreme. Who are they trying to fool? That's like writing down one potato chip. Unless it was stale or had a fly sitting on it, that is lie, too.
Lying about salt use, caloric intake, or the amount of exercise is universal. I could easily lie about that myself. I love to eat. I love salt. I hate to exercise. When my own doctor asked those questions, I am tempted to stretch the truth, but why? He will know I am lying. I will know I am lying, so I just try to be honest.
I was listening to Jeff Foxworthy the other day talking about his dentist visit:
"Do you floss your teeth every day?"When a patient consciously fails to provide vital medical information, this is the same as lying. This is a very dangerous practice. For instance, if you have a heart murmur, you have to let your medical provider know about it. This is not the time to see if "your doctor is smart enough to catch it." Medical care is not a game.
"Well, not every day. I guess the last time they were flossed was when YOU did it!"
Accurate information about a person's sexual history is very difficult to obtain, especially from teenagers. Teenagers often lie as the first line of defense. They even lie about stuff that is not important. An accurate sexual history IS very important in order for your medical provider to assess health risks.
I stopped asking if a person was "sexually-active" since that statement can be misunderstood. The word "active" is vague and can mean different things to different people. I once had a teenager respond to that question by saying, "What to you mean? Do I like, move around a lot during sex?" So now, I simply ask teenagers if they have EVER had sex...in any form. I don't want any of those Bill Clinton answers. When a teenager tells me they have never had sex and I find out they are three months pregnant, we need to have a long talk. Unless a star rose in the East, or someone is a very heavy sleeper, that someone is not telling the truth.
People always lie about the number of sexual partners. Some men are proud of their life score, so I always cut that exaggerated number in half. On another sexual issue, I once read that said that "Ninety percent of all men masturbate. The other ten percent lie." Whether someone masturbates or not, is really not an important sexual question. If your doctor asked you about it, he is just "weird," so it's okay to lie. If you are asked if you masturbate, just proudly say, "You bet! Every chance that I get. I was doing just before you came in."
Women tend count only significant sexual relationships; one-night stands don't make the list. They are probably afraid to tell me that they have had some God-awful number of partners for fear that I will think poorly of them. They always throw out a small number to throw me off track. Besides, what if someone read their chart? People may be whispering and grinning at them the next time the come in. For sensitive information like this, I tend not to write this stuff down in their chart.
I once took care of a 75 year old mother of a PA colleague. She was concerned that I would call her son and share her private medical history so she decided to test me. She told me that she was thinking about leaving her husband and having an affair with the bus driver. We discussed this at great detail. When that MIS-information never made it to her son (I would NEVER reveal confidential information like this), she eventually told me the affair story was just "a lie." She was just testing my level of confidentiality. Rather than be amused by this act, I dismissed her as a patient. Personally, I think she was hitting on that bus driver.
Related Topics: Technorati Tags: medicine, honesty, health and wellness
22 Comments:
What an entertaining article! I agree with everything said. People need to quit lying to health care professionals-their lives may depend on it.
Thanks for making me laugh!
funny but sad in a way...there should be a strong level of trust between you and your dr., they do take an oath of confidentiality after all.
this was a really informative article, very well written.
i am always sober enough to not tell my doctor how much i drink
I don't think dropping the fibbing patient was necessary because after all, you WERE her son's partner. And unfortunately I HAVE over-heard doctors and nurses gossip.It wasn't as if this lie was endangering her health.I don't blame her and she DID end up telling you the truth. I was once dropped by my doctor of 10 years and never found out why. I could think of no good reason except that I had just lost my insurance. However I was paying up front with cash at the time and owed no money. I never did figure it out, except I told people all over town this particular doctor was a quack.That was for not giving me an explanation! I now have Medicare and I know that particular office hated Medicare though. But I thought I deserved an explanation. I have always said there are two people you never lie to: Your doctor and your lawyer. Neither can help,if they don't know the truth.
Trust is earned, even (and especially) in the physician/patient venue.
Could it be that the partner's mother, even after 10 years, still wasn't entirely comfortable with you? Something must have caused her to make the decision to test you like that. Your dismissing her after she came clean with you probably felt a lot like vindication to her, too - and I'm afraid that I wouldn't have blamed her if it did.
If her notions were due to her age, then a bit of forbearance was called for; if they were due to distrust, then addressing the reasons for the lack of trust, warranted or not, might have been a better solution than dismissing her.
Although I enjoyed your article, and agreed with almost everything you wrote, I simply had to speak up about your reaction to the elderly lady.
Physicians are regular people - some are worthy of complete trust, and some simply are not. Don't blame a patient for trying to find out which you are, if through your actions of over a decade, you haven't yet managed to engender a sense of trust in her.
I use to lie to My Doctor.... I am a recovering alcoholic... do you drink... yeah a couple of beers... I quit in 89 and haven't looked back but I have had a a lot of medical procedures since 95 and have learned the more honest I am the better chances I have of surviving... especially if you forget to mention you have asthma and are going under general anasthesia... anyhow.... It is best not to lie to your Doctor(s) I have a team of 5... just in the past year 2 have had back surgery to keep me out of a wheel chair, Bladder cancer and treatment for 6 weeks and continuing tratment for 1 year once per month... and found out that I have had a heart attack at some point just a few weeks ago... so I better be honest.... even if it isn't what the doctor wants to hear...
In response to the folks saying that it was wrong to dismiss the elderly patient, I disagree. Either she could trust the doc in spite of his relationship with her son or not. She proved that she couldn't trust him. It's a bad idea to be with a health provider you can't trust, so kudos to Dr. Moser for cutting her loose to find someone who she can trust.
Maybe she couldn't overcome the idea that her son was a friend of his no matter what. Whatever the reason, if it was holding her back from having an honest dialog with her health provider, she should have changed.
Come on! She did a little test and it worked and Dr. Moser took it personally. Even a bit childish in his dismissing her. I hope he at least told her why and there were no hard feelings. It wasn't the same with my doctor of 10 years. We'd become almost friends! And he writes me a letter to tell me he would no longer be taking care of me? Doctors are NOT Gods, though many i've run into think they are. It's OK to test the water to see if it's too cold. Dr, Moser should have laughed this one off and they should have decided, together, if the mother of his partner was going to remain his patient. Personally, I would feel insecure about having a doctor in the same office as a relative of any kind. Not all doctors are good at "doctor/patient confidentiality" and I would have had to have had a doctor that didn't know my relatives personally. But I would be happy to have some free medical advice(like:"You need to see a doctor") from my son, the doctor.
A patient doesn't always have time to tell everything about their physical or mental situation. We get 5 minutes if we are lucky and we are expected to very precisely tell you about a single problem--the reason for making the appointment. There may be 1,2 or 10 other problems as we get older and the body deteriorates but there is only time for discussing what I consider the most serios problem i am facing. Are we dishonest when we don't tell you that we are also suicidal but I have gotten over that in the past or that my left leg is discoloring but it is not painful and not my highest priority? Come on! Give us some guidance on how to be patients--none of us ever get any education on it except the school of hard knocks when an arrogant doctor tells me that he/she no longer trusts me and I need to go somewhere else.
Regarding women, sex and what doctors think:
http://www.self.com/livingwell/articles/2007/05/0607_drdenial_singlepage
I also feel that dismissing the patient because she had some trust issues was inappropriate. You're the professional.
Dear doctors,
Pharmacists make mistake, doctors make mistake too.
Well, well, aren't we just too perfect! When you dimissed this patient you really put a wall of miss trust out there.
Sounds like her first impression was correct. Doctors like YOU GIVE EVERY DOCTOR A BLACK EYE!
I am offended that the patient was dismissed because of this “test”
There are legitimate reasons for not trusting doctors. Just look at the number of video voyeurism charges (170) and sexual battery charges (43) against my ob-gyn. I saw him for 30 years and he delivered three of my children. Calcasieu parish, Louisiana
Yes, I decided that another provider in my office...someone that did not know her son....would be more impartial and allow this elderly woman the assurance of confidentiality she desired. I chose not to see her because of her lack of trust that I would disclose information to her son. Once she broke that bond of trust, I found it very difficult to have a provider/patient relationship with her. I tried, but I always had this underlying feeling that she was (a) not telling me the truth, or (b) testing me, yet again.
We left on very good terms and we both felt better with her seeing another provider in our office....I know I felt better. Sometimes, familiarity with patients can be a barrier to unbiased care. If her son ever called me and asked about her mother's case, I could truly say "I don't know...you will have to call her doctor."
Well, I feel very reassured that you performed perfectly and the patient was the one at fault. Given this discussion, I don't feel I could ever trust you as my doctor.
Wow, anonymous 12:26 am...
First of all, where did Dr. Moser say that he was right and she was wrong? What he said was that he found it difficult to trust her after her little test and felt more comfortable putting her with someone else in the practice.
I would just as soon have a provider who doesn't share friends or family with me. I would also have a problem being completely frank if they were a close friend of my son or daughter.
It seems to me that it worked well for all involved -- she gets a provider that she trusts but remains friends with Dr. Moser, and it's all good.
In a broader sense, I have some difficulty with the idea of 'testing' my provider. If I felt that I needed to 'test him', I'd probably just change providers rather than do that. It's an unprofessional thing to do to a professional.
Someone higher up in the comments said that there were legitimate reasons not to trust a provider. I disagree. If you have legitimate reasons to distrust them, you should find one you do trust rather than staying with that one. Even the most restrictive insurance allows for changes in primary care providers.
when i was a med student, i delviered a 12 y/o of a healthy 10 lb. son. she denied ever having had sex ( anyway it was asked-- including using street language). the mother of the girl denied that the girl was involved with anyone. it turned out, the baby was the product of an inscestuous rape. learned early that a good doc has to be a good detective.
My guess is that the author of this article gets lied to a little more often than most, because he comes across (in print, at least) as a judgmental jerk. If I found myself under his care, I might very well lie to him and then quickly find myself another doctor (preferably one that is an actual M.D., unlike this individual).
Sincerely,
Someone who typically eats just one Krispy Kreme donut at a time and who had a doctor-initiated, medically relevant conversation with my gynecologist about my masturbation habits just last month
The thing I think you are all missing is the point of this article was to have patients stop lying to their doctors. I think he was simply trying, and succeeding, to be more funny then serious. Dr. Moser seems like a good doctor and a nice man. He was trying to approach the subject in a light-hearted manner, rather than so serious. I think it's his choice whether or not he feels comfortable with a patient, and it's not like he left the elderly lady in the street, he even went so far as to find her another doctor. You all are being so harsh to a man, who has good enough advice and experience that he is employed, or whatever, to be on a website that you use for information about important health related questions. He obviously has creditability. Stop being so judgemental and just learn to have a laugh.
Maybe we can help you
http://pergola.prohosts.org/
Wait a minute here--- What about doctors treating intelligent women in a condecending manner at our appointment right from the start, and recording FALSE information about the situation in the MEDICAL RECORDS!
IVE HAD IT WITH LYING DOCTORS WHO WRITE THINGS JUST TO PROTECT THEMSELVES, completely make up things you said, MOST PEOPLE DO NOT LIE!
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