Some patients aren’t so candid with their doctor
KEITH BEATY/Torstar News Service
You’re feeling rather vulnerable sitting there on the examining table in the doctor’s office.
After all, you’re naked underneath that ridiculous hospital gown. Boxes of medicines with intimidating names and strange metal objects that look like torture devices lie ready on shelves. You can hear muffled bits of hallway conversation, unnerving words like surgery, hemorrhage, transfusion.
Then a doctor in a white coat starts asking you questions about your health. Do you:
Tell the whole truth?
Pare down the amount of cigarettes and booze and boost the exercise?
Fudge the fact that you frequently forget to take your medicine?
Decide not to mention those odd dizzy spells, they’ll probably go away?
"I don’t lie, but I shade things because I don’t want trouble," says one former cancer patient. "I put up a good front."
Patients are their own spin-doctors. While a few people outright lie, scamming for pills or a note to cover a work absence, others massage the truth.
For some, it’s a reflex, a sort of "fib or flight" response to a stressful situation. Some anxious to find a family doctor – only 11 per cent are accepting new patients according to the College of Physicians and Surgeons of Ontario – might paint a too-rosy picture in hopes a busy doctor will take them on.
Others skirt the facts because they don’t want to disappoint their doctor or be judged, or they haven’t admitted the truth to themselves.
"The word lie is too harsh," says family doctor Larry Reynolds of Winnipeg.
"Patients can be less than candid, mostly out of fear and its cousin, embarrassment."
Not being honest can be self-defeating, leading to life-threatening situations such as drug interactions, overdoses or advanced disease, warn doctors.
Short of ordering polygraph tests along with the blood work, doctors develop their own intuitive not-quite-the-truth detectors, such as the way a patient might hesitate, an inconsistency in a story. Some doctors will double or triple a patient’s low-ball estimate on weekly alcohol consumption. Many use communication strategies — asking open-ended questions, delicately framing sensitive matters, not sounding judgmental — to encourage honesty. "It’s about a doctor creating an environment of trust," explains internist Wendy Levinson, chair of medicine at the University of Toronto.
Researchers also devise other supports, such as asking waiting patients to fill out computer questionnaires about health risks, from car seatbelt use to domestic violence.
In a Chicago study, the computer questions increased the detection and discussion of depression and interpersonal violence, says Levinson.
Preliminary data from a Canadian study show similar results. She speculates that not only is the computer impersonal, but the sensitive questions seem more routine, embedded with others. And scientists at Toronto’s Mount Sinai Hospital have come up with a urine test that reveals if people are really eating healthy foods. Jig’s up on the French fry diet.
In a totally unscientific survey, Torstar News Service asked 12 people in downtown Toronto if they lie to their doctors. Seven were aghast at the idea. "That would defeat the whole purpose of going," snipped one.
Five fessed up to fibbing or fudging. Standing outside an office building on cigarette breaks in frigid weather, one intrepid smoker said she tells her doctor she smokes about half the amount she really does.
"I tell my doctor I take my calcium pills, but I don’t," says another. "I don’t want to get the lecture."
"I lie all the time, whenever I don’t want to go to class or work," admits a 23-year-old university student. "I tell my doctor I have a headache or migraine and need a note."