I believe that with all communication between humans, a certain amount of “lying” often takes place.
Folks present partial truths, or nuanced truths, or deflect questions they don’t want to answer directly. I appreciate the doctor’s office setting, because our entire purpose is to help our patients. Because of this, patients typically want to be there, and many of our patients have waited for weeks or even months to be seen.
If a patient chooses to lie to me, I assume it is because they are embarrassed, or regret to even admit that they are ill. Sometimes patients lie to get me to discuss a different scenario for their condition, which is what they’re hoping can apply for them eventually. Such patients are trying to direct the visit by nuancing the truth. This is not helpful for me, but I understand the behavior.
Regardless of whether patients are being truthful, I am always coming from a place of profound empathy, and strive to create an environment where our patients feel both safe and respected, and therefore able to discuss with me freely. Like most doctors, I feel like I’ve seen it all, and there isn’t anything I haven’t heard. It’s impossible to gross me out or shock me! There isn’t anything a patient can tell me or show me that I will find offensive. Please just tell me EVERYTHING so I know best how to help you.
That said, I KNOW that patients sometimes lie, and I do try to figure out when that is happening. Lying to a doctor is inherently difficult because we have objective evidence. For example, if I prescribed a medication for blood pressure at the last visit, and the patient tells me they have been taking the medication faithfully, but the blood pressure is no different, then I suspect they are lying.
When there is no objective evidence for the question, such as “how is your depression?”, or “are you having sex with men, women, or both?,” then the chances of the patient successfully lying is higher. In that case, we learn clues to pick up on whether is patient lying. Even if I don’t confront the patient on lying, I will likely note my suspicion in the chart.
Here are some clues that a patient may be lying.
-First, if I ask a question and initially get nothing, then after a delay the patient begins to respond, I suspect they have altered the truth.
-Next, a deceptive person will often hide his or her mouth or eyes while being untruthful, such as by placing their hand in front of their face.
-Interestingly, a deceptive person may nod affirmatively while saying “No,” or turns his head from side to side while saying “Yes.”
-Fourth, if a patient clears his throat or performs a significant swallow prior to answering the question, that’s suspicious behavior. They may be formulating a lie, or the question caused so much anxiety that they actually got throat discomfort.
-Fifth, and similarly, I take note if the patient begins to touch their face in any way after a question. For example, the patient may begin biting or licking their lips, or pulling on their lips or ears. The question may have caused anxiety, which caused blood to drain from the face, which makes the person’s face feel cold or irritated, and they are responding to this.
All these are clues that make as believe a patient is lying. Remember, we’re all on the same side, and we are only here to help you!