Of 1,500 responders to a 2004 online survey by WebMD, 45% admitted they hadn’t always told it exactly like it was — with 13% saying they had “lied,” and 32% saying they had “stretched the truth.”
Not included in those figures would be patients who “lie” without knowing they do so by withholding information because it slips their mind or they have no idea it could be useful. (Maybe Aunt Agnes would gladly tell about the time she snored so loud she woke the neighbors if she knew that a diagnosis of sleep apnea could depend on it.)…
…In the WebMD survey, 38% of respondents said they lied about following doctors’ orders and 32% about diet or exercise. Doctor reports bear this out.
“Patients are strongly motivated to have their doctors think they’re good patients,” says Dr. Steven Hahn, professor of clinical medicine at Albert Einstein College and an internist at Jacobi Medical Center in New York City.
It’s hard to make a good impression when you’re on an examining table in a flimsy, open-backed gown — a fact that might make lying that much more tempting. But even fully clothed, talking face to face across a desk, a patient cedes authority to the doctor. And people generally like to please those in authority, says Emanuel Maidenberg, clinical professor of psychiatry at UCLA.
Patients also are prone to lying about the fact that they engage in social taboos, things their doctor might not approve of. In the WebMD survey, 22% lied about smoking, 17% about sex, 16% about drinking and 12% about recreational drug use.
“When you’re studying psychiatry, you’re taught that if a patient says, ‘I use cocaine once a month,’ you figure it’s twice a month,” says Dr. Robert Klitzman, professor of clinical psychiatry at Columbia University. “We were taught to double.”
…But co-workers, parents and spouses aren’t the only threats hanging over a patient’s head. Health insurance is another. And so — not surprisingly — sometimes people lie in order to keep something out of their medical records or out of the hands of their insurance companies.
That can be of genuine concern, say doctors and patient advocates. What happens in the doctor’s office doesn’t always stay in the doctor’s office.
Anything and everything health-related that patients tell their doctors is supposed to go into their medical records. That information is confidential, protected under the federal Health Insurance Portability and Accountability Act.
But in fact, it’s only confidential until it isn’t.
Whenever patients apply to buy individual insurance policies, and whenever they file claims under policies they own, the insurance company can request their medical records.
Patients can refuse to release the records, but if they do, the company can refuse to sell them a policy or refuse to pay claims. This is part of the deal patients agree to by signing on to the insurance contract.
And it doesn’t take much in a patient’s records to nix the sale of a policy. “A case of acne can do it,” says Jerry Flanagan, an advocate with the Foundation for Taxpayer and Consumer Rights.
And there are other insurance complications. If, when processing a claim, the insurance company finds something in a patient’s records that contradicts something the patient said when purchasing the policy, the company can retroactively cancel the policy, Flanagan says. Then it can demand reimbursement for any claims it has already paid — even if those claims had nothing to do with the reason for canceling the policy.
“I would never advocate lying to your doctor,” Flanagan says, “but I can definitely understand why someone might.”
Hat tip: @geekstats
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