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    Truth be told

    Honesty in the doctor-patient relationship not what it seems

    As a youngster, George Washington famously chose to tell the truth rather than to prevaricate in the hopes of escaping punishment: “Father, I cannot tell a lie. I chopped down the cherry tree.” We don’t have many George Washingtons around these days.

    We doctors should probably always think the best of our patients, honoring and respecting them. But that can be hard sometimes, because they are a bunch of liars. Does this seem a bit harsh to you? Well, a recent review of studies on patient veracity reveals some striking findings:

    • In a 2009 survey of 2,000 patients and 1,200 physicians, 29% of patients admitted lying to their doctors.
    • Twenty-eight percent of physicians thought that the majority of their patients lie to them on occasion.
    • Younger patients (25 to 34 years of age) are more likely to lie than older patients, and men lie twice as much as women.
    • They lie about smoking, about whether they are taking their medicines, about how often they exercise, about alcohol intake, and apparently about anything that might be embarrassing or they otherwise don’t want included in their medical records.

    Doctors also lie. One-tenth of respondents in a survey of 1,800 physicians admit saying untrue things to patients, more than half have given patients unrealistically positive prognoses, and 20% don’t come clean about mistakes they have made because they fear malpractice suits.

    A friend of mine, a high-ranking official in a professional medical society, once told me why his organization had stopped surveying its surgeons about their volumes and complication rates.

    “Every time we’ve done a survey and compared it with operating room records, we’ve found that the surgeons claim they are doing three times the number of procedures they are actually performing,” he said. “And the complication rate is at least twice what my colleagues self-report.”

    Fuzzy math

    Many doctors do what I was taught as a medical student learning about physical diagnosis; they double the number of alcoholic beverages that a patient admits to imbibing. A dentist named Sam Weisz reports that he divides in two the number of times that his patients claim to floss their teeth. The sobering underpinning of these strategies is that, on average, we cannot trust our patients to be honest.

    After a long day in the office, I had completed my usual daily hour-long exercise regimen, including 5 miles on the treadmill and 100 sit-ups. After a dinner of tasty salad (organic greens) and a glass of pomegranate juice, I flossed my teeth and settled down to ponder the implications of such shameless mendacity in the American public.

    In my opinion, there are two major logical consequences from the fact that the Washingtonian obsession with truth is largely extinct:

    1. It is unrealistic of us physicians to expect patients to fully comply with long-term medical therapy (pills or drops) for chronic diseases like diabetes and glaucoma. We should make it a priority to develop new surgical procedures with acceptable safety and efficacy profiles or sustained-release drug platforms that will make frequent drug administration over years a thing of the past.

    2. Anticipating that our internists will multiply by two whatever we say, we should divide by four when answering their questions about alcohol consumption.OT


    ‘I don’t smoke, Doc’ and other patient lies. Health and Wellness section, Wall Street Journal, Feb. 19, 2013.


    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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