It's a rule many residents learn in training. If a patient says he has four drinks a week, consider it eight. The same for cigarettes and illicit drugs, doctors say.
The not-so-subtle message underlying the practice: patients lie.
"It's just human nature that patients want to please doctors," says Kevin R. Campbell, a cardiologist in Raleigh, N.C.
"I've had patients say they quit smoking and yet they come in smelling like tobacco," he adds. "I can throw pills and drugs at patients all day long but if they're still continuing to smoke and that sort of thing it's just not going to help."
Patient liesâfrom half truths and deceptions to bold, blatant liesâare surprisingly common and can be hard to detect in today's hurried medical practices, doctors say. And as many doctors strive to move away from a stern and lecturing stereotype, confronting patients without alienating them can be especially challenging.
Common lies include everything from diet and exercise regimens to medication adherence, sexual histories, and taking alternative medicines. Doctors say some patients play down symptoms out of fear of a diagnosis or hospitalization. Others play up symptoms to obtain something such as a handicapped parking permit or a controlled substance.
In what may be a sign of the mistrust: however often patients lie, their health-care providers think they lie more. In a 2009 survey, 28% of patients surveyed acknowledged sometimes lying to their health-care provider or omitting information. But the health-care providers surveyed suspected worse: 77% said that one-fourth or more of their patients omitted facts or lied, and 28% estimated it was half or more of their patients.
The survey, conducted by General Electric (GE) Co.
Patients ages 25 to 34 were more likely to lie than older patients, according to a 2004 online survey of 1,500 respondents conducted by consumer medical news website WebMD (WBMD)
Some patients lie out of embarrassment or fear of disappointing a doctor. Others worry about electronic medical records or information being communicated to employers, insurance companies or the authorities.
Doctors say omitting important information or lying can lead to the wrong treatment, medicine or even diagnosis.
Jeffrey Cain, a family doctor in Denver, had a patient whose blood-pressure medication didn't appear to be working, so he changed the prescription. "What he hadn't told me was he wasn't actually taking his blood pressure medicine," Dr. Cain says.
The patient read a story about heart disease that scared him and then started taking all his medicationsânew and old. His blood pressure dropped so low that he passed out, Dr. Cain recalls.
In some cases, Dr. Cain says, patients are lying to themselves. They want to project to their doctor the image they want for themselves. Sure, I'm watching what I eat, Doc. Yes, I exercise regularly.
Maureen Mack is guilty of that. The 42-year-old tells doctors she exercises three times a week, 30 minutes each time. Reality is more like once or twice a week for 15 minutes.
"Why do I do it?" says the public-relations director who lives in a Milwaukee suburb. "Because I'd like to set myself a standard and try to live up to it so every time I write it I convince myself that I'm going to do it and the next time I go to a doctor it will be true. Hasn't happened in nine years."
Ari Brown, a pediatrician in Austin, most often catches parents lying to her when they disagree. Dr. Brown, for example, believes babies should be off a pacifier by six months or a year due to potential dental or language issues. Once, a mom said her daughter had given up her pacifier. It didn't come up again until the girl, then 2Â½ years old, fished a binky out of mom's purse during a visit and popped it into her mouth.
"The mom was like, 'Oh thanks, you totally just outed me,' " Dr. Brown recalls.
"I think that parents probably lie or omit information when they feel like they might be judged," Dr. Brown says. As a pediatrician for 17 years, she says she used to be more confrontational. "Now it's kind of, we just leave it out there."
Yolanda Reid-Chassiakos, director of the student health center at California State University, Northridge, once saw a college student whose parents suspected she was suffering from anorexia nervosa. An initial weight check, though, didn't show any weight loss. A second check of the student in a hospital gown found a loss of 15 pounds. "She admitted she had stuffed rocks in her clothes, in the pockets, so she could make her weight look a little more close to the normal range," Dr. Reid-Chassiakos says.
Doctors themselves shade the truth, studies find. "There are lots of complicated reasons why physicians don't always tell patients the entire truth," says John J. Palmieri, a psychiatrist at Massachusetts General Hospital who wrote a 2009 article "Lies in the Doctor-Patient Relationship" that appeared in the Journal of Clinical Psychiatry. "People will dance around [a diagnosis]," says Dr. Palmieri, citing Schizophrenia as an example. "They'll be concerned about using particular language and give a more generalized diagnosis."
A study published last year in the journal Health Affairs found that just over one-tenth of more than 1,800 physicians surveyed had told patients something untrue in the previous year. More than half said they described a prognosis in a more positive manner than warranted and about 20% admitted to not fully disclosing a mistake to a patient due to fears of litigation.
Some doctors say they look for signs of lying, such as avoiding eye contact, pausing or voice inflections, and other signs of anxiety.
"It takes time to draw out a patient and get them to reveal signs that they're exaggerating a symptom," says Peter Clarke, director of the Center for Health and Medical Communication at the University of Southern California. "And if you're effectivelyâby the work flow of your practiceâallocating 12 to 15 minutes per patient, you're not going to pick up on a lot of those signals."
Elizabeth Lee Vliet, who has an Arizona-based internal medicine practice, says she tries to ask very specific questions, particularly about over-the-counter medicine usage. "Patients are medicating themselves with so many over-the-counter herbs and supplements," she says, which can have potentially dangerous side effects, particularly in combination with prescription drugs.
For dentists, flossing is the most common issue. Sam Weisz, a dentists in Libertyville, Ill., simply divides whatever a patient says by two. "We can definitely tell by taking measurements under the gums each visit," Dr. Weisz says. The dirty truth: The dentist knows you're lying through your teeth.
Write to Sumathi Reddy at email@example.com