Patients not always truthful when dealing with clinicians

April 10, 2019

Dishonesty from patients can not only undermine care, it can cause unexpected harm.

A recent study shows that patients fail to disclose pertinent information to their physicians, which can undermine patient care or even cause unexpected harm.

Scientists at University of Utah Health and Middlesex Community College led the study in collaboration with colleagues at University of Michigan and University of Iowa. The research was conducted to determine if a conventional belief that patients lie to physicians has merit. Previous studies that attempted to examine this hypothesis were limited in scope, usually examining a single issue. This study attempted to focus on the types of behavior deemed basic and essential to health care and the characteristics of the nondisclosure.

“If patients are withholding information about what they’re eating, or whether they are taking their medication, it can have significant implications for their health. Especially if they have a chronic illness,” said the study’s first author, Andrea Gurmankin Levy, PhD, MBe, an associate professor in social sciences at Middlesex Community College in Middletown, Connecticut.

The study used two separate surveys. The first sample was recruited from users from Amazon’s Mechanical Turk (MTurk) marketplace, a population of internet users who participate in surveys and other tasks in exchange for financial compensation. These participants were age 18 and older. The second sample group, aged 50 and older, was obtained from Survey Sampling International (SSI) and received reward points for their participation. Both online surveys were self-administered.

Of 4510 total respondents, 2011 (mean age of 36 years, range 18-79) completed a MTurk survey, and 2685 participants (mean age 61 years, range 50-91), completed an SSI survey. In both groups, approximately 80% of participants were white. Of the MTurk and SSI participants, 60.7% and 51.5%, respectively, were female. Nearly 80% of the respondents reported their health as good, very good, or excellent. Chronic illness was reported by 22.5% of those in the MTurk group and 39.2% in the SSI group.

Medically relevant information was divided into types with reasons for avoiding the truth regarding that information. The information included disagreeing with the clinician’s recommendation, not understanding instructions, an unhealthy diet, not taking prescription medication as instructed, not exercising, taking a certain medication/not mentioning taking the medication, and taking someone else’s medication. 

Of the MTurk participants, 81.1% reported being untruthful with their physicians about any of seven types of relevant information. The same was true of 61.4% of those in the SSI group. 

The most common reasons for avoiding the truth included not wanting to be judged or lectured on behaviors, not wanting to hear something is bad, being embarrassed, not wanting to be seen as difficult or stupid, not wanting to take up the provider’s time, and not wanting information recorded in the medical record.

 

“I’m surprised that such a substantial number of people chose to withhold relatively benign information, and that they would admit to it,” said Levy. “We also have to consider the interesting limitation that survey participants might have withheld information about what they withheld, which would mean that our study has underestimated how prevalent this phenomenon is.” 

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