It’s no secret that the doctor-patient relationship is built on trust. Patients rely on their doctors to provide accurate diagnoses and appropriate treatments, while doctors depend on patients to give complete and truthful information about their symptoms and medical history. However, many patients are not fully transparent with their physicians for a variety of reasons. In this article, we’ll explore some of the key questions around patient honesty:
Why would a patient be dishonest with their doctor?
There are several reasons why a patient may not be entirely truthful with their doctor:
- Embarrassment about certain symptoms or behaviors. For example, patients may be uncomfortable disclosing struggles with mental health, sexual health, substance use, or nonadherence to medications.
- Fear of judgment or lecturing from the doctor. Patients may worry their doctor will disapprove of their lifestyle choices or behaviors.
- Concerns about privacy and confidentiality. Patients may be apprehensive about sharing sensitive health information.
- Worry about impact on treatment. Patients may withhold information if they think it could lead to denial of care or unwanted interventions.
- Difficulty remembering all relevant details. Patients simply may not recall important points to share with the doctor.
- Communication barriers. Language, cultural differences, health literacy gaps, and other issues can impede open dialog.
Many of these factors are rooted in the fear of being reprimanded or feeling shame about one’s behaviors and health circumstances. Patients may see the doctor’s office as an intimidating or judgmental environment.
What types of information do patients commonly omit or misreport?
Patients are most likely to be dishonest about information they find sensitive or embarrassing. Some examples include:
- Sexual history, partners, orientation
- Adherence to medications, treatments
- Use of illegal drugs or excessive alcohol
- Mental health issues like depression, anxiety, eating disorders
- Abuse or trauma
- Over-the-counter drug use
- Complementary supplement use
- Personal habits like diet, exercise, smoking
Patients may also unintentionally provide inaccurate information about:
- Family medical history
- Dates or details of prior diagnoses, hospitalizations
- Events leading up to onset of symptoms
- Prescription and OTC medications and dosages
This can occur simply because patients have trouble remembering exact details versus intentionally withholding information. However, even omitted details due to forgetfulness can impact the accuracy of a diagnosis.
How common is patient dishonesty?
It appears that a significant percentage of patients are not fully transparent with doctors. Studies have found:
- Up to 80% of patients do not adhere exactly to medication regimens prescribed by their doctor.
- Up to 65% of patients lie about illegal drug use and alcohol consumption.
- Over 50% of patients leave out key facts about diet, exercise, and smoking habits.
- Over 10% of patients keep quiet about experiencing domestic violence.
- 65% of transgender patients say they have not disclosed their gender identity to their doctor.
Clearly this is a widespread issue affecting a large number of patient-doctor encounters. While not all of this is intentional deception, it demonstrates that partial or total patient dishonesty is relatively commonplace for many sensitive topics.
Why is openness and honesty important in the doctor-patient relationship?
There are several reasons why it is crucial for patients to be honest and forthcoming with their doctors:
Leads to wrong diagnoses
Doctors rely on symptom reports and patient histories to make diagnoses. Information gaps or inaccuracies can throw off the process, leading the doctor down the wrong path. This means patients may receive incorrect diagnoses and unnecessary or potentially harmful treatments.
Interferes with appropriate treatment
Just as an incorrect diagnosis can lead to inappropriate treatment, so can missing information about a patient’s full health profile. Lack of honesty about substance use, nonadherence to prescriptions, and omission of other clinical details means doctors cannot choose the optimal treatment plan.
Puts patient safety at risk
When patients are not forthcoming about health behaviors, doctors may prescribe medications that negatively interact with the patient’s lifestyle or unreported drugs/supplements. Certain tests or procedures could also be contraindicated for a patient’s actual condition in ways the doctor would not know without accurate health data. This puts patient health and safety at risk.
Damages the doctor-patient bond
The foundation of an effective clinical relationship is trust and good communication. Dishonesty from either party erodes this critical foundation. It inhibits fruitful dialog and collaboration, which are essential for productive doctor-patient partnerships and positive health outcomes.
Results in higher healthcare costs
Incorrect diagnoses and treatments due to partial information lead to duplicative tests, procedures, and office visits that may not have been needed with accurate data. This drives up costs to patients, insurers, and the overall healthcare system.
Strategies for physicians to encourage patient honesty
Patient dishonesty is often unintentional, stemming from embarrassment, fear of judgment, or poor communication habits. Doctors can take proactive steps to foster openness and honesty from patients:
Set a non-judgmental tone from the start
Patients need to perceive the doctor’s office as a safe, accepting space versus a site of shaming. Avoid assumptions about patient behaviors and reinforce confidentiality at the outset. Display diversity/inclusivity symbols like rainbow flags or stickers.
Ask open-ended questions
Ask about alcohol use with “How often do you have a drink?” versus closed-ended “Do you drink alcohol?”. Open-ended questions allow more nuanced answers.
Watch language and body language
Avoid verbal and non-verbal signals that could shame patients, like dramatic reactions to disclosures of substance use or sexual behavior. Maintain engaged, neutral body language.
Remain non-judgmental when patients disclose
If a patient reveals something they likely find embarrassing like prescription nonadherence, remain neutral. Avoid lecturing. Reinforce the disclosure will stay confidential and guide patient toward improved adherence without shaming.
Follow up on gaps
If patient provides an incomplete history, ask thoughtful follow-up questions. Allow opportunity to share full, unfiltered information.
Explain the clinical rationale
Help the patient understand how complete information directly impacts diagnosis, treatment, and their health. Most patients want to improve health outcomes, so this motivates transparency.
Involve other staff
Receptionists, nurses and physician assistants can help establish an open, shame-free office culture. Extend the mission of honesty-building throughout the practice.
Discuss barriers to adherence, truth-telling
Unpack reasons for patient omissions like forgetfulness, language gaps, cultural barriers, or privacy concerns. Then provide solutions tailored to the obstacles.
Consider written surveys
Anonymous questionnaires prior to visits can encourage disclosure of stigmatized info like sexual behavior, mental health struggles, substance use, and abuse.
How can patients become more honest sharers?
While doctors should maximize comfort and openness in clinical settings, patients also have a responsibility to prioritize honesty and transparency during medical encounters. Patients can:
Reflect on their motivations
Contemplate any personal hesitations around truthful disclosure – are you embarrassed about certain symptoms? Worried about being lectured? Think through motivations and remind yourself that honesty leads to optimal care.
Write details down
Keep an ongoing list between visits of symptoms, medications, lifestyle factors, and questions to share. Review before appointments.
Bring a trusted advocate
Ask a supportive friend or family member to accompany you to appointments. Their presence can provide comfort and accountability around honest dialog.
Communicate needs pre-appointment
Call the doctor’s office pre-visit to share sensitivities around certain subjects and preferences for how the physician broaches these topics.
Ask about confidentiality processes
Understand the measures in place at the doctor’s practice to protect patient privacy. This provides reassurance around disclosure.
Have a telemedicine visit first
For sensitive subjects, consider a telehealth session to establish comfort with the doctor before an in-person visit. Being at home may make you feel safer sharing.
Share through patient portal
Disclose whatever you can on sensitive matters through secure online patient portal messaging before the appointment. This allows time to provide background.
Request same doctor
Ask to consistently see the same one to two practitioners at a practice. Comfort and rapport build over time, encouraging openness.
Switch doctors if needed
If you truly feel your current doctor shames you or threatens confidentiality, it may help to switch to one with better bedside manner.
The risks of doctor dishonesty
While the onus falls more heavily on patients to disclose health details, physicians also have an obligation to be honest and ethical in dealings with patients. Doctors who are intentionally dishonest risk:
- Serious harm to patients from inappropriate treatments or withholding of necessary care
- Violation of patient trust
- Damage to their professional integrity and practice reputation
- Potential legal consequences for negligence or willful misconduct
- Loss of medical licensure
Even well-meaning doctors can inadvertently mislead or fail patients through unconscious bias, outdated medical knowledge, poor communication, and other unintentional oversights. This underscores the need for physicians to consistently reevaluate their own perspectives and practices.
Examples of physician dishonesty or misguidance include:
- Over-billing for services
- Ordering unnecessary tests for financial gain
- Withholding test results
- Breaching patient confidentiality
- Providing misleading medication information
- Minimizing risks or side effects of procedures
- Concealing potential medical errors
- Exaggerating their credentials or expertise
- Making biased or outdated treatment recommendations
While less common than lack of transparency among patients, physician dishonesty can severely destroy the doctor-patient relationship when it occurs. It is critical for practitioners to uphold medical ethics by being truthful, transparent, and patient-focused – setting the standard for honest dialog.
The impact of dishonesty on the doctor-patient relationship
Dishonesty from either party can significantly degrade the crucial bonds between doctors and patients that enable effective healthcare:
| Damaged trust | Both patients and physicians rely on one another to disclose accurate information and offer optimal advice. Lack of honesty erodes the basic trust upon which this relationship is built. |
|---|---|
| Poor health outcomes | Incomplete or misleading information from either side leads to improper diagnoses and treatments, putting patient health at risk. |
| Reduced satisfaction | Patients may become less satisfied with their care and “doctor shop” if they feel physicians have been dishonest or judgmental. |
| Nonadherence | Patients who feel shamed about behaviors may further conceal the truth and fail to adhere properly to medications and treatments. |
| Lower quality care | Without open communication, doctors cannot deliver truly patient-centered care tailored to individual circumstances. |
| Increased costs | Duplicative, erroneous tests and treatments from poor information sharing drive up costs for patients, insurers, and the healthcare system. |
Partial truths and misinformation from either doctors or patients threaten proper medical care, strong therapeutic alliances, patient safety, and health system efficiency.
The benefits of openness for both sides
While honesty in the clinical setting is clearly vital, it can still feel difficult and vulnerable for doctors and patients alike. Reminding both parties of the meaningful benefits of truthful dialog can help motivate transparency:
For patients:
- Better treatment plans custom-designed for your needs and circumstances
- More accurate diagnoses when physicians have all relevant details
- Improved health outcomes based on proper therapies and adherence support from your doctor
- Avoidance of negative drug interactions or treatment complications by disclosing all medications and supplements
- Enhanced trust and communication with your doctor when you initiate open dialog
For doctors:
- Make proper diagnoses with comprehensive patient histories
- Select appropriate therapies when considering medications and lifestyle factors
- Boost patient adherence and outcomes by understanding obstacles and customizing care plans
- Strengthen doctor-patient relationships built on mutual trust and understanding
- Avoid mistakes or complications by having complete health profiles
- Lower risk of malpractice claims through proper informed consent processes
When both sides understand the meaningful benefits honesty brings for each party and patient care overall, they can find motivation to overcome barriers to truthful dialog.
The role of empathy in doctor-patient communication
Fundamentally, many patient omissions and doctors’ oversights stem from lack of empathy and understanding for each other’s experience. Physicians hurriedly moving between complex cases may not relate personally to an individual patient’s fears and emotions surrounding disclosure. Patients may see doctors as removed professionals and not grasp the clinical implications of omitting health details.
Cultivating mutual empathy is key to unlocking more open communication. Doctors who take time to see through the patient’s eyes often find patients become more honest in response. Patients who grasp the physician’s goal to provide best care possible based on clinical facts may also grow more forthcoming.
Steps doctors and patients can take to gain and convey empathy include:
For doctors:
- Sit at eye level versus standing over the patient
- Ask open-ended questions about the patient’s experiences
- Actively listen without interrupting the patient
- Express understanding by rephrasing patient statements
- Acknowledge patient emotions and concerns
- Use thoughtful body language like nodding
For patients:
- View the doctor as your care partner versus an intimidating authority
- Remember doctors aim to improve your health, not pass judgment
- Be aware doctors rely on accurate info to determine proper treatment
- Share ambiguities, struggles you have around following medical advice
- Ask doctors to explain the rationale when you don’t understand
This spirit of empathy helps build collaborative doctor-patient relationships where both feel safe being open and honest – to the ultimate benefit of patient health.
The takeaway
Honesty and transparency between healthcare providers and patients is the vital foundation enabling accurate diagnoses, effective treatment plans, therapeutic alliances, and optimal outcomes. While doctors set the tone in their offices, patients also play a key role being truthful about symptoms, behaviors, and experiences that influence health.
There are many barriers that contribute to omissions and misinformation on both sides – ranging from forgetfulness to fear of judgement. But the meaningful benefits honesty brings should motivate both groups to continue striving for greater openness through empathy, trust-building, and effective communication focused on the end goal of improving patient health.