Deadly ‘Little’ Lies

Most healthcare professionals and experienced caregivers know that patients lie.  They may “embellish” the facts; leave out a detail or two; or “forget” some inconvenient truth.  They may lie about how much they smoke, drink, eat, or exercise.  They may lie about how faithfully they take their medication.  They may lie about symptoms or problems they are experiencing.

A recent Johns Hopkins study demonstrated the gap between what patients say and what they do. When patients with breathing problems were given specially monitored inhalers, 73 percent of them claimed to be using the inhalers three times a day, but only 15 percent of them did.   

Many patients lie without intending to, consciously at least.  They may not see an “omission” as dangerous because they figure it is a detail too small to mention.  Or they may be on their best behavior – reducing alcohol intake, taking their meds, exercising – in the days before a doctor’s appointment, convinced that they’ve been on their best behavior.

Even small “omissions” of details can have devastating consequences, however, leading to delayed or wrong diagnoses, too many or too few medical tests, dangerous intermingling of medications, and potentially deadly results.

With all this at stake, why would our loved ones lie to those charged with protecting their health?

• Shame.  They may feel embarrassed about how much or how little they eat.  They may be embarrassed to admit they are taking a tranquilizer. 
• Denial.  They may not even admit to themselves they drink as much as they do. Or that they are having anxiety attacks.
• Guilt.  They know they are supposed to be walking every day, and they haven’t been.  They know the danger of smoking – yet they can’t kick the habit.
• Desire to be a “good” patient.  They don’t want to complain, or admit that a treatment regime is not working.  They don’t want to waste the doctor’s time – or yours -- by appearing to have more problems.
• Fear of offending the caregiver.  They don’t want to admit it hurts when you lift them, or that the home-health arrangements you’ve made aren’t working.
• Fear of losing insurance coverage.  Some patients will mask symptoms, or pretend to be following orders for fear that the insurer will deny them coverage.
• Fear of their physician or caregiver.  If a physician or caregiver is harsh or judgmental, the patient may react by concealing information or giving the answers they believe will result in positive reactions.
• Protecting family members.  Patients – particularly children and the elderly – may lie about bruises or weight loss to cover family or caregiver abuse issues.

What can you do if you suspect a loved one is concealing important medical information? 

• Monitor what you observe about how well your loved one is following medical instructions.  Don’t accuse without educated observation.
• Talk to your loved one about your concerns, without casting judgment.  Accusing your husband of lying about his smoking is unlikely to improve the situation.  Asking nonjudgmental questions with a measured tone will lead to a better exchange.
• Talk about the importance of telling the truth – and the consequences for not doing so.  “If we don’t tell the doctor you are taking Xanax, he might prescribe medication that will have a terrible side effect on you.”
• Assure your loved that there is nothing he or she can tell a physician, nurse, or healthcare professional that will be offensive or inappropriate.  The physician is not insulted to hear that the patient has not been following instructions, or offended to hear that pain has returned. 
• Be loving and supportive.  Statements like “I will help you explain what you are feeling,” or “I will help the doctor understand why this is a problem for you” can pave the way for more honest exchanges.

Is it ethical to intervene with the physician, nurse, or professional caregiver and “tell the truth” if you loved one isn’t?

• Not without telling your loved one your intention first.  “Dad, if you don’t tell Dr. Stevens that you are still experiencing leg pains, he cannot help you, and I love you so much that I’ll tell him.”  If you let your loved one know what you’ve observed and why full information-sharing is essential, this conversation will go better.

• Not in a way that humiliates or casts judgment on your loved one or the healthcare professional.  “Dad is lying about his drinking again,” will not improve the situation, nor will “Dad is afraid of you, Dr. Johnson.”  If you are caring for an adult loved one, you must recognize (as hard as it is) that he is ultimately in charge of his own life; infantilizing them will not result in better health outcomes. 
• Absolutely yes, when the loved one in question is a dependent child or whenever concealing a medical situation will result in imminent danger. 

 

The situation may be more easily handled if you have a private conversation with the physician or a member of his/her staff beforehand.  You might want to suggest that your loved one fears “wasting” the doctor’s time, suggest what types of questions may elicit more truthful responses, or explain the need for your loved one to have a better discussion of consequences.

If your loved one is consistently withholding information from a physician, the relationship will not work for either of them. It may be time to seek a new physician or to talk to a nurse, social worker, home health aide, or caseworker who may be able to mediate between the two.