Not Telling Your Doctor The Whole Truth Can Be Deadly

Did you tell any white lies at your last doctor visit? Maybe you were too embarrassed to mention a sexual problem or didn't want to be lectured about skipping your medication. Research reveals there's nearly a 50-50 chance that a patient won't tell the whole truth during a medical checkup-but withholding even minor information from a physician can lead to needless suffering and misdiagnosis.

Robert Klitzman, MD, an expert on medical privacy and disclosure, talks about the lies patients tell...

• Why do patients lie so often to their doctors? The Web site WebMD did a survey recently that found that half of all patients who lie do it because they don't want to be judged. About 30% say the truth is just too embarrassing to reveal. Others lie to avoid a lecture from the doctor...because they don't think the information they fail to disclose is important...because they don't want to appear stupid...or because they don't want the truth in their records.
  

Many patients don't consider it lying to leave out information. If the doctor fails to ask about a particular condition, these patients don't feel the need to bring it up. Patients may not even realize that they're failing to provide the entire truth. This is common with men who don't report to their doctors that they're feeling irritable or tired. They don't recognize that these could be symptoms of depression.

• What do patients lie about most often? The big one is adherence to treatment and medication. A patient doesn't do what his doctor directs, but he's afraid the doctor will get mad if he says so. Also, patients often lie about behaviors that they perceive as taboo-smoking, alcohol and drug use, and sexual issues, such as impotence and infidelity.
  
• Does telling "white lies" to your doctor really compromise your health care? Let's say you are prescribed an antibiotic for a week. After three days, you feel better, so you don't bother finishing it. Your doctor asks, "Did you take the antibiotic?" You respond, "Yes." After all, you did take it for a while and you are feeling better. However, if the infection recurs, your doctor may now treat you with the understanding that the antibiotic you took wasn't effective when, in fact, it may have been if you had finished the pills.
  

Also, "small" problems you ignore or conceal can lead to more serious ones. A man may have a persistent ache or pain but delays going to the doctor. Months later, the pain gets so intense that he can't delay any longer, only to learn that he has cancer or a heart problem that could have been caught earlier.

• Is there ever a good reason to lie to your doctor? This gets into a gray area. Say that one of your parents has Huntington's disease, a progressive, degenerative brain disease for which there is no cure. You want to get a genetic test to determine if you have the gene associated with the disease. If the results are positive, do you really want that on your permanent medical record? Legally, your doctor cannot divulge the contents of your chart without your permission—but potential lapses in privacy are a legitimate concern. If you have insurance through work, someone in human resources might gossip, and then your employer could find out about your condition. While there are employment laws that protect you from discrimination, all kinds of subtle discrimination do exist, such as getting passed over for a promotion.
  

I can see why patients sometimes feel the need to withhold sensitive information. What I would suggest instead is having a candid conversation with your doctor. Say, "I'm interested in having genetic testing done. I'm concerned because I don't want the results added to my permanent record. Would you be comfortable with that?

• How can a patient get past his fears and inhibitions? There are several strategies that can be effective. One is to discuss the underlying fear up front with your physician. Say, "Doctor, I have something I want to mention, but it's awkward." A doctor's reassurance—There's nothing to be embarrassed about. I really have heard it all before"-often can relax you enough to speak freely.
  

You also could send the doctor an E-mail before your appointment or hand him a note in the exam room if you can't say what you need to out loud.

Or use a "surrogate approach." Ask your spouse or son or daughter to speak with the doctor. Lots of men come in for checkups with their wives. The husband doesn't want to admit he's in pain, so the wife tells the doctor.

Another way to bring up a sensitive topic is to do so with a different member of the medical team. If you have a good rapport with a nurse, say to him/her, "I feel badly that I haven't been taking my medication as I should. Could you please tell the doctor for me?"

It's very important to avoid compounding communication gaps. The longer you withhold information from a doctor, the more you compromise your chances of getting the best treatment possible. Say, "There are some things I need to mention that I'm afraid I haven't told you in the past."