Monday, February 19, 2007

Everyone Lies

I just read a post about patients who lie [it’s TrenchDoc, I’m just too lazy to link it]. Everyone lies. I lie. Witnesses, clients, bloggers, men, boyfriends, imaginary boyfriends, pretend boyfriends, ex-boyfriends (take it easy MA, they get the picture). They all lie. Why should patients be any different, even if it may kill them?

In law school, a professor once told us that everyone will lie to us, especially our clients (and not just the criminals). He said we would have to learn to ask the same question over and over, in different ways, so that we could learn what the truth actually was. Because no matter how bad the truth is, it is still better to hear it from your client alone in your office, rather than in a deposition, etc.

My question is: Is this something a doctor is taught in medical school, so they are prepared for patients who lie? Or is this something you learn on your own, through experience? And if it is taught in medical school, do med students immediately embrace the fact that all patients will lie to them? Or does it take awhile for them to accept this? Do you always go in assuming the patient will lie? Even the slightly nervous girl lawyer or the sweet Grandma sitting in your examining room?

Of course, I guess I shouldn't mind the reluctant truth-challenged client. I'll sit there all day listening to you dance around the truth, because my billing meter will be running every minute. And please, feel free to take that cell phone call during the middle of our meeting. I can always use the billable hours.

15 comments:

View from the Trekant said...

My biggest shock about a patient lie came during training. I was sent in to see a women who looked like one of my grandmother's friends right down to the support hose and house dress. I dealt with her hypertension and lipids.

My attending came in after me. She promptly asked blue-haired grandma "How much heroin are you using now?"

"None! I told you I've been clean for 3 months!"

I now pretty much ask everyone about drugs, at least on the first visit. (Still feel nervous doing so when it's a prominant citizen.)

As to be being taught about liars in medical school - we were taught to ask questions that were less likely to lead to a negative answer:

Not "Do you drink?" but "How many alcoholic beverages do you drink a day?"

SeaSpray said...

Very interesting. I love the billable hour thing. So different for you as opposed to doctors who have to get everyone in to make the money - you just let that meter run. :)

trenchy said...

One should NEVER ask "how much heroin"... just ask, "are you still finding a fix", or "are you out of smack", something along those lines.

difficultpt said...

"Keep a watch also on the faults of the patients, which often make them lie about the taking of things prescribed."

Hippocrates

jmb said...

Excellent post, MBA. Obviously not taught in medical school but pretty soon learned on the job, I'm sure. I guess an ER doc has seen everything so assumes everyone has something to hide in the end. We all want to appear in our best light, hopefully we can be truthful when it counts.
jmb

MedStudentGod (MSG) said...

Almost every medical student experiences the fact that patients lie - often when they enter clinical training. The history taken by a medical student is often completely different from that garnered by the resident which then differs from that obtianed by the attending physician.

I think I want a tattoo of a caduceus symbol with the words: "Patients Lie" underneath.

#1 Dinosaur said...

The problem is that although many people lie, we must assume that they are telling the truth until faced with incontrovertable evidence to the contrary. If you ask someone if they're allergic to penicillin and they say "yes," would anyone in their right mind say, "Oh, they're probably lying. Go ahead and give it to them."

I've been lied to left, right and center. You just have to learn not to depend on negative answers to things like sex and drugs and alcohol, which means learning how to get at the truth (LFTs, macrocytosis point to alcohol abuse; etc.)

Testing has its perils too, though. A woman who claims not to have had sex but has a positive STD or pregnancy test could be a sexual assault victim.

Developing that "sixth sense" of when a patient is lying (because some are so damned good at it) is an important clinical skill that only comes with time/experience, even though it is alluded to in med school.

Not Nurse Ratched said...

We had a whole giant unit in nursing school regarding how to phrase questions just so to minimize the chances of being lied to. For example, one asks the same question slightly differently throughout the patient history in order to trap the unwary patient who changes her answer. Your post made me think of the show House: he is always saying patients lie! It's his primary assumption. I love that show. ;)

Bongi said...

i once saw a patient with a spoon stuck in his rectum. yes you read that right!!! the guy had shoved a table spoon right into his rectum. just to hear the lie i actually asked how it happened. well apparently he was painting and fell off the ladder. i didn't ask him why he was painting in the nude or how the spoon stood up on its end. i just assumed that was self evident.

Bongi said...

just an after thought, my abovementioned experience lent itself to many afrikaans wordplays, so...
toe ek die pasient gesien het het ek vir hom gese moenie roer nie, ek is nou daar. ek neem aan die waarheid van hoe dit gebeur het is dat sy baas vir hom gese het om sy gat te roer en toe maak hy so.


sorry for the afrikaans for the international bloggers, but it is lost in translation.

Sid Schwab said...

I'd say it's not so much taught as learned, even in med school. There are no lectures in lying (although there were some lecturers so damn bad they may have well been lying), but the evidence is around for the absorbing.

amy said...
This comment has been removed by a blog administrator.
Bohemian Road Nurse... said...

My technique for getting the truth out of my patients (whether they are deliberately trying to hide something or else they're very forgetful and truly can't remember) is to sit there and chat aimlessly for awhile, while commenting multiple times on the issue I'm trying to figure out. Sooner or later, a patient's comment will "reveal" what's really going on. I look like a complete air-brain while this is going on--and I'm sure the patients probably wonder why in the heck I'm boring them to death---but it works...

Denever said...

A related but more slippery problem: the unreliability of self-reporting. One of my relatives - elderly, mildly depressed, and there's nothing particularly unusual about those two things going together - had two different doctors ask her, "Are you depressed?" No, she said. Okey-doke, they said, that takes care of that.

As everyone reading this blog knows, the better questions would be those that go directly to the symptoms of depression without actually mentioning the D-word because a lot of people, especially those of the suck-it-up-and-don't-complain generation, will simply deny that they're "depressed."

They aren't lying, but their self-assessment is not reliable.

Anonymous said...

I have found that many Doctor's lie to their patients....and when they cannot figure out what is wrong (usually because they have not kept up to date on current medical guidelines or standards of care) they tend to blow the patient off and tell them to seek Psychiatric help (as the person who posted above just did)....

Many medical issues (ie: hypothyroid, hyperthyroid, adrenal issues...basically all endocrine issues) can cause physical, cognitive, as well as emotional issues (ie:depression)....

Referring to Psychiatry or ordering an antidepressant for a patient who has never before had signs/symptoms of depression seems to be the first step an uninformed, and thus an unwise, Physician will take.

Doctors should listen to their patients....for it is the patient that has lived in their own body for many years----NOT the Physician.
I have heard residents and interns state their patients report that they believe they have a certain medical issue and yet the resident/intern will tell their Attending that they 'don't think this is the case'....
When questioned by the Attending as to why, they have no response.

The astute Attending reminds the resident/intern that it is a primary mistake NOT to listen to the patient.....many times *they* are correct!

Many patients do not lie and to assume they are is not being a patient advocate.
I find when Doctors partner with their patients greater health can be found....and in not assuming they are lying, but listening and using critical thinking skills one can then take steps to correct their medical issues.