Will doctors and patients ever trust each other?

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One of the common comments made by doctors is that when patients tell you a number for alcohol or drugs for example, double it. So few patients are thought to be honest with their doctor’s that this is the safest way to get an estimate of this information. I have seen more and more articles recently on the frustrations of doctors about the fact that patients seem to always lie: “yes, I work out every day,” “no, I never smoke,” “of course I don’t have more than 2 drinks a night!” These lies are not only dangerous for the patient’s health, but they damage the doctor-patient relationship.

As someone who is honest with her doctor I am especially frustrated by this because it also impacts me negatively. When I tell my doctor that I don’t drink I know that she doesn’t believe me. When I tell my doctor how often (or little!) I work out I know she’s probably halving that number and wondering what else I’m lying about. This is just as dangerous as lying about my health. In this situation I tell the truth but the doctor is still altering the numbers in her head because she assumes I’m lying. This can often lead to worse situations that occur because the doctor assumes your symptoms are alcohol or drug related. In her book Brain on Fire Susannah Cahalan talks about how her life-threatening symptoms were first attributed to alcohol withdrawal, which is not at all a unique situation. There are countless stories of people seeking help for medical problems and being told that it is drug-, alcohol-, or diet-related based on numbers that the doctor has altered in her own head. This is especially true of the less well-known and chronic diseases that have a wider range of symptoms.

Ironically, one of the other key reasons that people are not honest with their doctors is due to a fear of having their symptoms labeled as being as a result of whatever the “bad” behavior is. What is unfortunate is that this fear is warranted. If someone is honest about drug use or eating “badly,” then the doctor is more likely to attribute the symptoms.

Please don’t get me wrong here; I am not blaming the doctors. They are doing what they have been taught to do and what, sadly, is correct in the majority of situations. Have you always been honest with your doctor about “unhealthy” habits?
People lie to their doctors all the time and it’s creating a doctor-patient relationship filled with mistrust and apprehension.

I think one of the key reasons for patients’ lying has to do with public health policies and interventions. As public health professionals have had a larger say in policies and medicine we have begun to see far more chastisement and shaming around “bad” behaviors. Doctors are now supposed to talk to patients about these things and tell them “smoking’s bad”, “don’t binge drink”, “exercise regularly”. The problem is that we know this by now and that is why most of us are lying.
Of course I know that sitting in front of my tv all evening, eating junk food, and not working out is not exactly good for me, but I’m not visiting my doctor for a lecture. The same is true for most other “unhealthy” behaviors. Do you know any smokers who don’t know by now that smoking is dangerous? Of course they know, and many may lie to their doctor about smoking because they don’t want another lecture.

How many overweight individuals have not been body shamed at some point in their lives? If an overweight individual visits the doctor and she asks about their diet they are not going to want to receive yet another lecture and shaming. While in most cases the information provided by doctors is not intended to be preachy and shaming it often comes across as such, and this can be just as dangerous to the relationship as it will severely inhibit, or even shut down, communication.

There needs to be a more open middle ground, where doctors are less judgmental and are open to providing guidance and advice if desired but not if the patient does not want that information. Patients need to be more open to doctors and doctors need to be able to take the time to talk with patients to get a greater understanding of the problem. If a person comes in with multiple, vague complaints and then says they drink heavily it is far easier and faster to assume withdrawal of some sort than to conduct a more thorough analysis. If the doctor weren’t so pressed for time she might be more able to consider other alternatives.

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