I am a bit naïve. Yes, I am a psychiatrist, a Clinical Professor of Psychiatry, and the founder of the National Center for Whole Psychiatry. Given my experience, I should, you would think, know better. Yet I was in practice for probably 20 or more years before I realized that some times my patients lie to me about how they are doing, and whether they are following our jointly agreed upon recommendations. I am prompted to write about this, because a week ago I had an experience where a patient told me that she was lying to her other doctor.
Now, using the word ‘lying’ seems a bit strong, but I use it to get the point across. In fact, it is more like hiding the truth, not wanting to disappoint the doctor, avoiding shame, judgment, criticism, or the doctor’s expected anger. Any reason that might inspire a child or adolescent to lie to their parent can probably be operative here because, understandably, being a patient is a vulnerable state for many.
My patient’s name is Joan. Joan is a 58-year old married accountant who has, for the past 15 months, been having odd symptoms—feeling like the walls are closing in on her, feeling unsteady on her feet all the time, as if she just got off a boat, seeing faces “melting”. A thorough medical and psychiatric work has revealed some underlying hormonal, nutritional, and immunological dysfunctions, which are contributing to the symptoms. As part of the medical work-up I referred her to a neurologist (Dr. Blandt), who prescribed a medication for Joan. When I next met with Joan, I asked her if the medication worked and discovered her lie. Our conversation went like this:
“Joan, what did Dr. Blandt say when you saw her last week?”
“ Well not that much, she had given me the Scopolamine, but I didn’t like it.”
“Did you tell her that?”
“What did Dr. Blandt say?”
“She said I should try different drug.”
“How long did you take the Scopolamine for?”
“Not very long, I took it once or twice.”
“Did you tell Dr. Blandt that?”
“I didn’t want her to be upset with me. I don’t want more drugs.”
“Joan, you have a right to not take a medicine, but you need to tell Dr. Blandt the whole truth and your concerns. Dr. Blandt may well conclude that the Scopolamine didn’t help you, and so it’s not helpful for the type of symptoms you have and other patients like you have. She will be less likely to prescribe it for other patients, based on the experience she believes you had. Dr. Blandt’s ability to help people is somewhat diminished by such erroneous information. When this happens enough a doctor’s ability to help their patients is compromised. You need to be more direct.”
I explained to Joan how her inaccurate reporting to Dr. Blandt could easily effect her ability to get relief through proper diagnosis and treatment her problem. A patient’s reaction to medication tells the physician something about the patient’s biology and clarifies the diagnosis.
Inaccurate reporting leads to inaccurate treatment not just for you, but for others with similar conditions or symptoms. If you fear telling your doctor the whole truth when you are face to face, consider writing her a note before you see her telling the doctor ALL the facts of your situation – whatever they are. You can certainly tell the doctor in the note that you have some fear or concern about telling him the whole truth. An understanding physician will appreciate your concerns and your honesty.