Editor’s note: The opinions expressed by the author do not necessarily reflect the opinions of the AAMC or its members.
A few months ago, I was about to go under anesthesia when I remembered that I’d drunk two glasses of wine the night before. I started to panic about whether that was a mistake. Yet I also dreaded trying to reschedule given how tough it had been to squeeze the procedure into my crazy calendar. I seriously considered concealing the information.
Then I contemplated two facts. One, you don’t mess around with anesthesia. Two, my colleagues and I had just conducted a study on patient prevarication, and I’d extolled the virtues of being honest with providers. I decided to confess to my drinking, was grateful to hear I didn’t need to worry, and then shared a good laugh about the difficulty of being honest with health care providers.
But patients’ misleading physicians is no laughing matter.
Physicians can’t accurately diagnose, treat, and advise patients unless the patients share information openly and honestly. Yet our study discovered that a huge chunk of patients — more than 80% — have concealed relevant information from their physicians. Why is that? And what can we do about it? These are questions with serious, potentially life-threatening implications.
In our study, we asked nearly 5,000 adults if they ever withheld information from their physicians on a range of topics, from taking someone else’s medication to not having understood the doctor’s instructions. Whenever participants admitted to concealing information, we asked them what motivated their dissembling.
Physicians can’t accurately diagnose, treat, and advise patients unless they share information openly and honestly. Yet our study discovered that a huge chunk of patients — more than 80% — have concealed relevant information from their physicians.
It turns out that the vast majority of our subjects — nearly 82% — said they didn’t want to be judged or lectured about their behavior. Wanting to avoid hearing how bad the behavior is came in second, at nearly 76%. The third most common response, at 70%, was feeling embarrassed. Not wanting to be seen as a difficult patient came in fourth, at around 50%. And nearly half of patients surveyed said they didn’t want to take up more of their provider’s time.
Although motivations for hiding the truth range widely, the options for addressing them are connected by one basic concept: a collaborative physician-patient relationship.
Communications that take a top-down approach are not likely to succeed. Instead, it makes sense to get alongside a patient to problem-solve together. Say a physician suspects that a patient who is already taking several medications doesn’t plan to take a new one. Rather than reiterating the need for the new medication, the physician could ask questions that acknowledge the patient’s reality. She might try, “Will taking another medicine overwhelm you?” or “Will it add stress to your family budget?” Armed with an answer, the physician could assess which of the meds the patient could possibly skip, a much better outcome than the patient omitting the last medicine prescribed — which could be the most important one.
Another great way to open up communication, especially around complex issues, is to apply the “teach back” method. After a complicated or lengthy conversation, a physician could say something like this: “I know that was a lot of information, and I want to make sure I explained it clearly. Can you please tell me what you got from our discussion?” Asking patients what they heard is much more compassionate — and effective — than expecting them to admit that they didn't understand the information.
Because so many people told us they want their providers to think highly of them, physicians need to find ways to make patients more comfortable admitting embarrassing behaviors.
A healthy dose of self-revelation also can help connect providers and patients. Compare “how many fruits and veggies do you eat?” with something like this: “I don’t know about you, but I find it hard to stick to a healthy diet as much as I should. How have you been doing lately?” By showing their own vulnerability, physicians help patients feel more comfortable admitting to less-than-ideal behavior, whether that’s eating too much or not exercising enough.
Finally, because so many people told us they want their providers to think highly of them, physicians need to find ways to make patients more comfortable admitting embarrassing behaviors. Patients may be more willing to open up if their providers start the conversation by assuring the patient that they aren’t here to judge. For example, a physician could say, “I know sometimes people worry about telling doctors certain things. But please know that I just want to understand all I can about you to make sure I’m helping with your health in the best possible way.”
To be clear, conversations about patients’ health behaviors are not easy. What’s more, medical students and residents rarely get specific instruction in class settings or clinical training on how to handle them. But given the seriousness of a physician not knowing vital information about a patient, we have an obligation to expand the lines of communication.
Of course, physicians need to find approaches that feel most comfortable to them, and it may take some significant trial and error to figure out how to encourage patients to reveal sensitive information. But if we can create more trusting, collaborative relationships, we may see healthier and more engaged patients. And if we don’t, we could be endangering the lives and well-being of those in our care.
Angela Fagerlin, PhD, is chair of the department of population health sciences at the University of Utah School of Medicine. She recently published a study on patients withholding information from physicians with her colleagues Andrea Levy, PhD, MBe; Aaron Scherer, PhD; Geoff Barnes, MD, MSc; Brian Zikmund-Fisher, PhD; and Knoll Larkin, MPH.