“My patients often told me the stories they thought I wanted to hear, even when the story did not reflect reality,” says Vicki Rackner, MD, a surgeon and founder of Medical Bridges. “Patients spin their stories to make themselves look better. When they stretch the truth rather than stretch themselves and follow their doctors’ advice, they’re hurting themselves.

She remembers a patient who said he took his medications that lower blood pressure and cholesterol. When he was hospitalized with his heart attack, he admitted that sometimes days or weeks would pass between doses of his daily medicine. He’ll always wonder if he could have avoided that heart attack by doing the things he told the doctors he did.

Patients’ failure to tell the whole truth – to their doctors and to themselves – is a significant barrier to quality health care and optimal health.

“Patients get the best medical results when doctors and patients are honest with each other,” says Dr. Rackner. She suspects that up to half of her patients were less than totally honest with her, and notes that even nice, upstanding members of the community tell tall tales to their doctors.

If we want to promote truth-telling between doctors and patients, we must first understand why patients spin their stories, suggests Dr. Rackner. She offers five common reasons that explain why patients stretch the truth, lie or just decline to give information.

1. Perception: Patients want to think of themselves as healthy people. They want to see themselves as responsible adults who eat healthfully, exercise regularly and don’t overindulge in alcohol. For some, getting a diagnosis from the doctor and being told to take medicine is simply not consistent with this self-image. They politely ignore the doctor’s recommendation once they leave the office. Instead of just thinking the doctor made a mistake, the patient can say, “ It’s hard to believe I have this illness. I feel totally healthy.”

2. Compliance: Many want their doctors to think of them as good patients. They don’t want to disappoint their doctors so they stretch the truth about whether they take medication as prescribed or how much they smoke or how often they floss their teeth. They may fear their doctors’ harsh judgment, particularly if they have different health beliefs, so they withhold information about the use of nutritional supplements or alternative remedies. They may even worry their doctors will fire them if the doctor knew the whole truth. Instead of spinning a story, the patients can be honest with the doctor and look for solutions. They can say, “I’m embarrassed to admit this, but sometimes I forget to take my medication. Do you have any tricks that will help me remeber?” or “I hate to disappoint you, but I cannot swallow a pill that large. Is there a liquid you can prescribe?” or “There’s something I have been meaning to tell you. I started taking glucosamine and it’s relieved my joint pain.” Patients under the care of judgmental doctors are best served by finding a new doctor.

3. “I’ll just sit in the dark” syndrome: These patients don’t want to trouble their busy doctors. They minimize the severity of symptoms or even fail to tell the doctor about new symptoms about which they complain bitterly at home. They falsely believe that if the symptoms were important, the doctor would ask about them or somehow know. These patients benefit from maintaining a written log of their symptoms, including a numeric description of the pain intensity on a scale of 1 to 10. They can bring this log and an “accountability buddy” to the doctor appointment. On the way to the appointment, the buddy can say, “Sometimes I hear you tell the doctor a different story than you tell me. I have your permission to speak up, right?”

4. Who are you fooling? These patients have a distorted sense of their own truth. Anorexics, for example, look in the mirror and see unacceptable body fat. Self-deception plays a role in many addictive behaviors. There are no good solutions to this problem unless and until this person commits to telling the truth.

5. Fear: These patients fear the consequences if the truth falls into the wrong hands. They lie to hide actions that are illegal, immoral or socially unacceptable. A patient who is brought into the emergency room might be reluctant to admit that the chest pain started shortly after his cocaine use. A woman may fear for her own safety if the doctor knew that she didn’t trip and break her rib; she sustained her injury when her boyfriend kicked her. The obvious solution is to avoid behaviors that must be kept secret. Short of that, patients can check with their doctors about the boundaries of medical privacy. They can say, “I would like to tell you something, and I am concerned about the consequences if my employers finds out. How do you handle these situations?” Even though doctors want to respect your privacy, they are required to report certain types of information to the authorities.

While these solutions focus on patients, both doctor and patient can and should contribute to a relationship in which it’s easier to tell the truth. Everyone benefits when that happens.

Vicki Rackner M.D. president of Medical Bridges, is a surgeon who left the operating room to help patients partner more effectively with their doctors. She's a speaker, author and consultant.

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