Social Question

josie's avatar

Why do patients lie to their physician(s)

Asked by josie (23360 points ) February 12th, 2013

My girlfriend is a doctor.

She occasionally expresses her amazement at the frequency with which patients lie or withhold information that is essential to proper diagnosis and treatment planning, thus deliberately putting themselves at risk.

She wonders if it is an “American thing”. (She is from the Middle East. “Her people” she says “would not be so foolish”. As a rule, I avoid cultural debates with her so I do not know if that part is true.)

But still, why would somebody lie to a physician about their history, drug use, medications, etc. and put themselves at risk.

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36 Answers

Adirondackwannabe's avatar

If it’s an addiction of some type it may be just from embarrassment that they can’t overcome it. They’d rather take the risk than admit a weakness.

JLeslie's avatar

Sometimes it is because the patient worries the doctor won’t do what the patient wants.

Sometimes it is bevause the patient has had a longhistory ofmdoctors being dismissive and the patient tries to guess what they need to say to be taken seriously.

Sometimes the patient is not lying from their perspective, they just don’t know what they are ommiting is relevant.

Sometimes it is simple miscommunication between the doctor and patient. The patiens does not fully understand what the doctor is looking for.

Sometimes the patient forgets, especially when dealing with long chronic illnesses. Memory can be incorrect, chronology of events blurred. Later memory gets jogged for one reason or another.

Sometimes the patient worries about being judged.

I would guess some people worry about getting into trouble if it is drug use.

geeky_mama's avatar

I agree with everything @JLeslie has said and I would add:

Sometimes the patient thinks they know better and is trying to skew the diagnosis one way or another.

Sometimes the patient is under the care of other doctors and if you’re seeing them for a single-time visit (e.g. Urgent Care) they are mentioning only what they feel is relevant to the current office visit. (For example, if I’m at Urgent Care for antibiotics for a Sinus Infection and I don’t explain to you that I have severe asthma and diminished lung capacity and routinely get pneumonia and that my immunologist gives me steroids and strong antibiotics for that…well, it’s because I know that I don’t have pneumonia today, I just have a sinus infection..so I’m sticking to the topic at hand, not my full health picture.)

JLeslie's avatar

I really question that her people would not be so foolish. I’ll assume she left her country when she was young, and has little idea of what it is like to be a sick adult dealing with a doctor. Most young doctors have no idea what it is like to be a sick adult dealing with doctors period. I don’t know how old she is. Many doctors have at least one parent who was a doctor, so they have grown up “inside” the system. Also, to make it through med school and residency a person generally has to be very healthy with tremendous stamina, and they don’t identify with people who are unheaothy or have a long history fo being unhealthy. Sure, eventually even a doctor winds up sick most likely during their lifetime, but by then they are “inside” the system where other doctors listen to them and treat them with respect and take them seriously and defer to hypothesis they might have about their conditions. I do think some countries are better than America at treating patients with patience and respect. All generalizations of course.

poisonedantidote's avatar

I have no idea why people do it, I can only guess at shame or something like that. My father does it, I think it is an attempt to take blame off himself, as beer is what is causing some of his health problems.

Personally, I don’t lie to doctors, that is like sabotaging your own car, then taking it to a mechanic and telling him it just stopped working and you don’t know why. I would always just tell them what is wrong, followed by my past, and all possibly relevant details about what happened.

Well doctor… I was filming myself naked with a glass jar, ready to upload to the Internet, when something went wrong.

Judi's avatar

If it’s drug use they might worry that the doctor would consider them an abuser and not prescribe more drugs for them.

marinelife's avatar

Shame and fear.

Linda_Owl's avatar

Frequently the reason is Money. They know that they cannot afford the extra money it would take to get a definitive diagnosis, especially if the tests must be done in a hospital setting. Most insurance plans have very high deductibles, especially where hospitals are concerned.

tom_g's avatar

^^ This. And a legitimate fear of insurance companies finding out, leading to the inability to get coverage when they “really need it”. Remember – we have designed a health care system that discourages preventive care. Also, have you ever mentioned something to a doctor and found out 6 months and $3000 later that everything’s “fine”? Many people don’t have the resources to be able to handle the consequences of being completely honest with their doctor.

KNOWITALL's avatar

@tom_g Absolutely correct.

burntbonez's avatar

I vote for shame, too. Have you had sex with anyone but a long term exclusive partner? No your honor doc. How did you fall on your head? I was too lazy to put salt on the steps I slipped on the icy steps. Why didn’t you come to me sooner? Well, if I knew it was cancer I wouldn’t have bothered to come at all. I thought it was just a head ache. Or a stomach ache. I didn’t want to bother you with nothing.

This is a nation where we are raised from birth to be ashamed of being sick. We work through our illnesses. It’s better to pass a flu to 100 people than it is to lose a day off work and get known as unreliable. Never complain. Complainers are losers.

It’s the culture that stigmatizes illness.

Seek's avatar

From the “Devil’s advocate” side,

Sometimes the doctor just doesn’t effing listen, and ignores the history the patient tries repeatedly to ram down their throat.

Kind of how I had to practically hold down the doctor and force him to stop giving me stupid expensive pointless tests and just do a frakking abdominal ultrasound to find the gallstones that I knew were there because every woman in my family going back five generations gets them.

And then looked at me and said “It appears that you have gallstones.”.

Idiots.

WillWorkForChocolate's avatar

Because refusing to tell my doctor he’s hot doesn’t have a thing to do with my treatment! Or does it…

I agree with both @JLeslie and @Seek_Kolinahr.

gondwanalon's avatar

I have never lied to a doctor about my living habits or history. But I have lied to my cardiologist about the dosage of a heart arrhythmia drug called “amiodarone” (a drug that has a very long list of crippling side-effects). I have been taking amiodarone on and off for 12 years. It use to work very well to control my condition of “lone paroxysmal atrial fibrillation”. Now it only works for me at dangerously high dose levels (800 mg/day). Therefore I get all of the side-effects with very little or no benefit. I recently asked my cardiologist “Why am I taking amiodarone”? Also “Why can’t I just take ‘coumadin’ (anticoagulant drug) and stop taking the amiodarone and live with atrial fibrillation”? I was told that my “CHAD 2” score was too low (in other words, I have no disease associated with my heart). Also I was told that the ”amiodarone will help my heart to maintain normal rhythm after my next cardioversion”. HA! I have have 7 cardioversions over the years and amiodarone’s ability to hold my heart in normal rhythm have diminished down to zero. I have been instructed to take 200 mg/day of amiodarone until instructed otherwise but I’m currently only taking 100 mg/day in order to minimize the harmful effects.

I know my heart (which is very strong) and I know that amiodarone does far more harm to me than good.

nicole29's avatar

It can be uncomfortable to tell the truth, when you know it’s not what someone else wants.. especially someone of authority. As others have said, people don’t want to be judged for their behaviors… or may deem a little while lie to be irrelevant. In school (pharmacy) we are being taught techniques to help get the truth out of patients, in a more conversational and complete way.

Traditional Questions: Are you taking your medication like I prescribed? Have you been checking your blood glucose twice a day? Have you been avoiding salt? Are you using protection?
Answer: Yes.
Truth: No.
Thought process: If I tell them the truth, I’ll be lectured. If I tell them yes, it’s what they want to hear, and they’ll lay off.

These yes/no questions can make people feel interrogated. Instead, we’re learning (and I’m assuming physicians are heading towards this approach, also) to ask open ended questions, so that patients can give us a more complete answer and are less likely to just pull the yes/no without explanation.

Newer Questions: How have you been taking your medication? When are you taking it? How frequently? What problems have you been having? What concerns do you have?

JLeslie's avatar

How about doctors don’t believe patients when they tell the truth. Can we complain about that on this Q? I am not trying to be obnoxious or start a list of complaints here, but what your gf says about patients, she has no idea how many frustrating doctors there are who seem sure patients lie. @nicole29‘s answer made me think of this. I spent years and bruned through a few doctors not helping me with my thyroid. They didn’t believe me. The first thing was I was allergic to synthroid, the medication. They kept me on that horrible med (horrible for me) until I insisted on being changed. Next, I don’t stabilize so they wanted to believe I don’t take my medicine consistently daily, and I don’t take it without food, which is necessary for proper absorption, etc. Finally a Nurse Practioner took what I said as truth, and finally I was the most stable I had ever been. She worked with me, and believed me. The science was there if a doctor a moment to really think and analyze my particular situation.

KNOWITALL's avatar

@JLeslie I tend to agree with you on that. Every doctor that I’ve seen except my current LOVES giving everyone unnecessary medications, I don’t get it.

One of the first things I will continue to ask any doctor’s treating me or my loved ones, is how they feel about medication versus self-help ie diet/ exercise/ natural methods.

JLeslie's avatar

@KNOWITALL Well, I needed the medication, I just needed to be on one I was not allergic to, and I need to be monitored closely so I never have my numbers move too far outside of normal. Think about it like this, most people take a dose, let’s say 100 mcg and their thyroid numbers stay stable. If I take 100 daily my numbers slowly move too high over about 3 or 4 months, they never stop, it will get higher and higher on that dose. So, every few months I have to change one pill weekly to the lower dose of 88mcg and then my numbers will go down and down, never stopping. Most people change their dose every day if they need to change, meaning they might lower to 88mcg daily, not just one day a week. So, doctors don’t believe I was taking he drug well, because people are not supposed have their numbers continue to move in one direction, the numbers should stop and stabilize, even if the stabilized number is not a good number.

KNOWITALL's avatar

@JLeslie I know some are needed, especially after my mom got cancer and my husband was diagnosed with general epilepsy. Doctors need to really LISTEN and it’s our responsiblity to make sure they listen or we go somewhere else, especially with medications.

cazzie's avatar

We have ‘free universal’ healthcare, so the fear of insurance companies and not being covered isn’t an issue here, so I would think that @JLeslie has the answer closest to the truth for most and that doctors don’t always listen, either, like @Seek_Kolinahr mentions. I stopped going to mine, so I guess we don’t listen to each other any more. Honestly, I haven’t been to my doctor in over a year and ignored a ‘you are due for a pap smear test’ notification and also suffer from a chronic condition (it only bothers me occasionally) but, meh. She wanted my chronic condition only treated by the specialist at the hospital. The specialist wanted to serve me a rotten cocktail of bullshit and I wouldn’t swallow it, so we are at a stand-off and it has pretty much been that way for 8 years.

JLeslie's avatar

The more sick you are, the less you are listened to. What I mean by more sick is not the severity of the illness, but rather if you have a chronic condition, or several illnesses close together.

burntbonez's avatar

I think that patients have a hard time talking to their doctors. I think many patients think the doctor is like god, and they have no business being mortal in front of the doc. Ironic. So since they can not be equal with the doc, they have to lie to him or her.

Doctors have created a myth of superiority. I don’t know if that is just here or everywhere. In any case, you’re not supposed to question the doctor. If you can’t question the doctor, how can you answer the doctor’s questions honestly? You must manipulate the doctor since you can’t be an equal with him.

Doctors need to open up equal dialogs. They need patients to trust them and they have to work to earn that trust. Until they do so, patients will feel uncomfortable with the truth.

wundayatta's avatar

In the area of mental health, patients often lie to psychiatrists about whether they are doing drugs or whether they are taking their meds as prescribed. The reason they do this is they don’t feel they have the power to speak to their shrinks. They think they’ll be hurt if they admit the truth. Yet the truth is crucial for proper treatment.

Mental patients have to force their doctors to listen, and yet they are in a terrible position to do so. The reason we don’t take meds is usually because of side effects. We need to tell our shrinks that the meds are intolerable and we need something else. Most patients just stop taking the meds and don’t tell anyone. They don’t even titrate off. They stop cold turkey, which can cause a lot of side effects.

We need better partnerships with our shrinks. We need to be in a more equal position. The doctors need to believe us, and we need to believe them. Otherwise the fight for health will be hindered, and that doesn’t do any of us any good.

Earthgirl's avatar

If I lie it’s with full knowledge that my nondisclosure will not affect the diagnosis or treatment. It is only as @nicole29 says, to avoid being lectured to. I’m pretty responsible but not perfect. I know what I should be doing to stay healthy and I feel like I have a pretty good control on it. So I don’t need my doctor to act as a parent figure. I’m not a child and I’m not stupid. As for others, I think a lot of the reasons previously stated are right on the money. Shame, avoiding unnecessary tests, etc.

One reason not mentioned is the insurance practice of pre existing conditions. A person might lie so that their insurance would cover something they had symptoms for before getting their current insurance. If they admit that they had symptoms or were treated for it before there is generally a period under which the new insurance will not cover the condition.

JLeslie's avatar

@Earthgirl If you were treated before it isn’t like your medical record disappears unless the other doctor agreed to bury the information.

wundayatta's avatar

Has anyone ever tried telling the truth about a shameful matter to see if the doctor lectures you? I have. No lectures. This is with both my doctor, the physician’s assistant and with a substitute doctor.

I think we read into expressions on their faces more than what they say. My doctor has deliberately not lectured me when he probably should have for fear I would avoid his advice. When I was getting mentally ill, he gave me a referral to a psychiatrist saying, only, that I “might” want to see one. He didn’t urge me to. He didn’t say it was important, although, it must have been very clear to him that I was in a good deal of trouble already.

I asked him why he didn’t make it more of an issue a year or two after hit happened, and he said that he’s had a lot of patients resist the advice and deliberately not go. So he tries to downplay it. And I can see this in his advice about exercise and diet, as well. He knows that lecturing doesn’t work. So he goes far in the opposite direction, with equal ineffectiveness.

It’s like telling your kids they aren’t listening when they don’t do what you say. They’re listening. They just don’t want to do what you say. It’s the same with doctors. When a doctor gives advice, we have this feeling we should do what they say or else what are we paying them for? But we don’t want to do what they say. A heart attack is too far away. It’s hard to see the connection between what we eat now and the heart attack in a few years.

Plus there are pills to take that keep the cholesterol down and the bp down. We are used to throwing pills at things or doing surgery instead of trying to take control with behavioral changes. Behavioral changes are the hardest to implement and we are ashamed of that. We live in a culture that believes you can do anything you want to if you just want to enough.

So being unable to change behavior is a failure of will. It is anti-American. And so both patients and doctors want to avoid bringing it up. We say we don’t want lectures. They say they don’t want to lecture. And between the two of us, we don’t deal with issue at all, except for drugs. We don’t even attempt to work out something realistic that might help make a behavior change we can live with.

My doctor gave me the numbers for weight watchers groups. Well, I had so many excuses. I don’t want to pay for help. I don’t want to discuss this with others. But the truth is that a support group is one of the most effective ways to make behavioral change. Everyone understands what you are going through. They don’t make you feel bad for being out of control. They support you when you make positive change.

I suspect we need support groups for all kinds of health change. Yet this, too, is anti-American. We don’t do things in groups. We do it alone. We are pioneers. It’s idiotic, this myth, but it is so prevalent and it keeps us from getting all kinds of help and it is probably a major reason why health outcomes in the US are so surprisingly bad compared to other first world countries. It would be interesting to do some research about that, anyway.

JLeslie's avatar

@wundayatta I had been surprised so many answers here say they lie to avoid a lecture or for shame reasons. I have never been lectured either, but the doctor might emphasize why something is important.

This Q reminds me of the last time I had a colonscopy and the nurse who took care of me before the procedure had to ask me a bunch of questions. One was if I took the entire prep for the procedure. I said, “no.” she looked at me like no one has ever answered no. She asked, “no?” My reply, “absolutely not, you probably prescribe the same amount to 220 pound men.” Then I told her how much I did take. People who answer yes so the nurse or doctor does not give them a lecture means 140 pound women continue to get overmedicated.

In my view being honest helps doctors know how treatments are working for their patients. If we lie how can they adjust their thought process on what they prescribe and things they recommend.

As far as shame, I never feel shame at a doctor’s office. But, I hear about this a lot.

I do omit info sometimes, because doctors sometimes latch onto a piece of information that they shouldn’t.

wundayatta's avatar

I have had health lectures, but not in the doctors office. In my group, we’ve had folks from the doctor’s side teach us how to take control of our health care. We are trained to be empowered to ask the doctors questions and to make them work for us, instead of us being “good patients” for them. After all, the doctors do work for us, not the other way around. But the culture of expertise makes it seem like patients work for doctors.

When I first got bipolar, I went to a new doctor to get checked for STDs. I didn’t want to admit to my doctor what I had done. Then I learned that hypersexuality is a symptom of bipolar. Had my doctor known, he might have made more of an effort to get me to see a psychiatrist. But I was ashamed of what I had done and didn’t understand why I did it, and so I felt I had to hide it. I didn’t want my doctor to think less of me.

But now he knows. I’m not sure what he thinks, but it doesn’t matter. What matters is my history is all in one place and he can now make better decisions because he has full knowledge of my history. We, as patients, may think things are unrelated, but that may not be the case. It is important to say everything, even things we think are unrelated, because there are strange relationships we don’t know about in medicine, and if the doctor has the whole story, they can dig up this information.

JLeslie's avatar

I agree that everything counts. All symptoms. Things can be related that seem completely unrelated, definitely true.

susanc's avatar

I love my g.p. He’s efficient and fast, he has a sense of humor and we can talk. I had shingles last year, which he diagnosed correctly when I thought I had a wrenched shoulder muscle. Miracle man. Then I had to go back in and force him to prescribe an antiviral shot, after I researched online, which he thought it was too late for. I said I don’t care if it’s too late, it’s inconclusive how long I’ve had symptoms, and if it’s possibly within the time limit for effectiveness let’s just assume it might be helpful, what harm could it do? He said Hmm, that makes sense. And it did help. We worked together. That’s what I want.

JLeslie's avatar

@susanc The harm can be everyone has different reactions and side effects to different meds. I like that your doctor doesn’t love to prescribe so fast. Do you mean you asked for the shingles vaccine? Or, some sort of antiviral shot, similar to Valtrex, that you could have taken the meds in a pill form and see how you do on it? Once ths hot of meds is in you, have the loading dose in you, period, you can’t stop taking it if it makes you feel horrible.

I don’t even understand having shingles as pain in your shoulder? Nerve pain? Did you have an outbreak?

mattbrowne's avatar

Because of the perceived threat to autonomy and status, see SCARF model:

http://www.scarf360.com/about/index.shtml

susanc's avatar

@JLeslie – this was a bit over a year ago. Yes, nerve pain, very severe, in shoulder beginning in the wrist and traveling up. Also outbreak of very itchy dots on forearm that took about eight months to really be gone. Very shocking nerve pain that made me think my arm was broken.
I didn’t ask for a shingles vaccine because I’d already had one. Doc prescribed Prednisone for pain but not antiviral because those aren’t supposed to work if given after the first five days after appearance of symptoms, and I’d had an actual wrenched shoulder before the “other” pain began, so I couldn’t identify the onset of the shingles-pain. But I went online (Answer.com) and a doctor there said go back immediately and get the antiviral anyway, it won’t hurt. I did and it helped a little teeny bit, but the virus was well installed by then and I was in bad pain for months, couldn’t sleep and stuff, grimacing against my will in public and itching embarrassingly and all the rest. And this was a mild case. God protect us all from this horror. Thanks for asking.
Outbreak? Of skin itches? Tried everything. Time was the most helpful. Also calamine lotion. Tried Capsicum, omg the pain. I guess the problem is that the nerves themselves are messed up, not the tissue the nerves serve, so treating the tissue doesn’t turn off the nerve signals. Sound right?

JLeslie's avatar

@susanc Oh, ok, that makes more sense. When you just said shoulder pain at first that made no sense to me, no one I kniw describes shingles like that. Often people don’t even mention which body part when they talk about shingles. I never do, and I don’t think jonsblond or auggie dies, not that I remember anyway, and we are the jellies who have suffered with it since a very young age. I think we all started in our 20’s and get repeat outbreaks.

cazzie's avatar

@susanc oh no! capsicum cream on shingles?! Not open new ones, I hope. Calamine and Lidocaine for me and mine.

The word in Norway for ‘shingles’ is Helvetes Ild (Flames of Hell). Prednisone is not a pain medication but a steroid used for inflammation. What are swollen and inflamed are the nerves themselves. From what I have read, Prednisone has no immediate effect or real use in most cases of shingles. In fact, there are new studies, because one of the side effects of corticosteroids is a lowered immune system, there is some belief that actually using them hinders the body’s own natural response.

From a copy of American Family Physician in April 2000:
Orally administered corticosteroids are commonly used in the treatment of herpes zoster, even though clinical trials have shown variable results. Prednisone used in conjunction with acyclovir (antiviral) has been shown to reduce the pain associated with herpes zoster. The likely mechanism involves decreasing the degree of neuritis caused by active infection and, possibly, decreasing residual damage to affected nerves.

Some studies designed to evaluate the effectiveness of prednisone therapy in preventing postherpetic neuralgia have shown decreased pain at three and 12 months. Other studies have demonstrated no benefit.

JLeslie's avatar

I’m glad you mentioned the prednisone @cazzie; I meant to address that. I would never take predinisone for shingles. Prednisone reduces our immune response. It is our immune response that fights of infection, so I would not take anything that reduces my chances off fighting off an outbreak. If during a post neuralgia faze I was desperate I might try it, or anything, but I still would be hesitant. I never would take it while the outbreak was active.

American doctors seem to be doling out Prednisone more and more, I have no proof of it through statistical data, but through family and friends I hear of them taking it for so many things that I never would. The most common one I hear is for coughs due to colds and bacterial infection when there is no reason to believe there is any threat of asthma, or any type of inability to breath. My dad was given Prednisone PO when a topical would have sufficed and he wound up with a DVT (blood clot) which we are pretty sure was caused by the medicine. He is high risk for DVT’s and they ignored it in my opinion.

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