Are Patients Telling You the Truth?

Trust is recognized as a fundamental aspect of the doctor / patient relationship. It is a concept that is highly valued by both parties and is separate from the term satisfaction. What is meant by a trusting relationship is giving your patients the opportunity to communicate how they feel, discuss their medical concerns, and question available treatment options. When patients develop this trust, they are more likely to follow your guidance, recommendations, and as a result, receive better care. Recent studies show that while more than 20% of Americans have overall confidence in the healthcare system, approximately 70% stress that they particularly trust and value doctors’ honesty and integrity.

When a patient gets sick, they expect you to help them get well. Most demand advanced diagnostic tools, some require prescribed medications but above all, all seek high-quality care. Yet, an astounding amount of patients withhold information that is relevant to their recovery. Some patients may lie to you because they fear being judged and they want to present themselves to you in an optimistic and enlightening approach. Others may do it because they are desperately seeking something for you, such as a medication prescription. Patient dishonesty is a rather serious issue that goes beyond trust. In some cases, it can compromise providing appropriate care. For instance, a patient may not disclose that they are secretly taking a particular medication and if you prescribe them other type of medication that counters the effects, it could lead to severe side effects or unwanted complications. A recent survey reveals that 38% of patients stretch the truth about following doctor’s orders, 32% lie about how much they exercise, 22% lie about smoking, 17% lie about sexual activity, 16% lie about alcohol consumption, and 12% lie about drug use. Moreover, the findings show that it is younger patients, between the ages of 25 and 34, that are more likely to withhold the truth.

So as a doctor, how do you know? How do you know when patients are lying to you? The fact is that there is no sure way to determine if your patients are lying to you. However, there are certain tools that you can use to stress the importance of accurate information and help the chances of a patient who is uncomfortable, to be open and honest. The gut instinct is one of them. When you ask a patient a question such as “are you a smoker?” or “how often do you drink?” depending on how quickly they answer the question, you may recognize if they are speaking truthfully. For instance, if they are hesitant for a few seconds, this may be an indication that they are not telling you the whole truth. The second tool is known as guilty body language. If a patient avoids eye contact or is constantly fidgeting, this is a powerful sign that they may be lying to you.

When you are ask your patients to answer questions relating to their health, keep in mind their motivation. Of course, it is easier to read patients that you have treated for several years; however, most individuals make the assumption that it takes more of an effort to lie than it does to tell the truth. In reality, for some patients, lying comes naturally and it actually may be telling the truth that is causing them worry. As a doctor, it is only natural to develop a healthy cynicism but you should not become a cynic. Most times, you may be able to put two and two together. For instance, if a patient is joined by a family member or loved one during their appointment, ask yourself “is it possible that they are withholding sensitive information because they feel uncomfortable in their surroundings?” or “it is possible that they are afraid of being judged?”

The third tool of certainty is lab results. No matter if your patient is not telling you the truth, lab results do not lie. At this point, some may crack under the pressure, admitting to being dishonest or they may choose to remain quiet, yet with the intention to be honest during their next appointment. The fourth tool that has proven to be effective is medical history review. Reviewing a patient’s medical history can help you to better understand their symptoms, condition, and possible treatment options. Moreover, if a particular medication or treatment is not working, a patient’s medical history can be reassuring and increase the trust factor.

When a patient’s lies prove to have potentially fatal consequences, it is your job to let them know of the consequences. It is not smart to be aggressive with them but rather let them know that the truth affects them far more than it does you. It is about letting them know that they could miss out on receiving proper care if they do not take good care of their health. The biggest challenge for most doctors is patients who request pain medication. Pain medication can be quite addictive and so it is very important to take the patient’s condition into consideration, as well as their own experiences. Before writing a medical prescription, ask your patients to sign a contract, specifying that they will follow the proper dosages at the proper interval.

Trust is a two-way street. Just as you hope that patients will be open and honest with you, they hope the same of you. At a first patient encounter, introduce yourself – who you are and what services you have to offer. Make direct eye contact and try to create a personal bond. All patients strive to find a doctor who they feel is confident, approachable, and caring. Make an effort to put the patient at ease by sharing something that will let them know they can speak freely around you. Sometimes, a patient may be reluctant to share their personal medical experiences because they do not know where the information is going to go or who it is going to be shared with. For this reason, it is imperative that they are aware of the doctor/patient confidentiality agreement and recognize that they are surrounded by a safe environment. This being said, the core elements that make up patient satisfaction are:

• Truthfulness
• Respect and dignity
• Patient expectations
• Patient control
• Open communication
• Clear and concise information
• Time well spent
• Continuity of care
• Referrals
• Reliable and dedicated healthcare team

Establishing an open and honest doctor/patient relationship is one of the most cherished relationships. As a doctor, you must be able to take in patients’ stress and concerns without losing insight and focus. You must take the time to listen and communicate honestly while putting them at ease. If clinical results reveal that a patient is being dishonest, confront them but do not be judgmental. Consider what they stand to gain or lose from meeting with you. Always aim to inspire and teach them the value of truthfulness and open communication, without having to feel humiliated or judged. Above all, treat your patients as individuals rather than a collection of symptoms - their integrity comes first.

When asked, “What makes a good doctor?” what comes to mind? A visionary leader who is confident and strives to provide a standard of care firm to their values and beliefs? An individual who has a kind heart and treats those around him or her with compassion and dedication? A loyal and reliable mentor who dedicates their life to creating and preserving health? Well, you are all of the above and more.

It is important to use your own experiences as learning opportunities and re-evaluate relationships to establish or rebuild confidence and trust. Generally speaking, the healthcare environment is rather large and complex. For this reason, most patients struggle to fully communicate their own feelings and understand their health. Yet, there is more than one approach to encouraging patient engagement and establishing trusting doctor/patient relationships. With your help, your patients can take more proactive roles and become advocates of their own health.