A new internet-based survey of 2,020 patients who had received treatment for depression, conducted by a Dr. Sawada and presented at the Annual Congress of the European College of Neuropsychopharmacology, revealed something that I have known about for a very long time. A lot of patients lie to their doctors.
About 70% admitted lying at least once! 66% stretched the truth about daily activities such as work while almost 53% were untruthful about their symptoms - on purpose.
That patients can be less than honest should come as not surprise to anyone familiar with the literature on patient compliance with doctors' orders.
In the United States, according to some estimates 20-30% of prescriptions are never even filled at the pharmacy. According to the World Health Organization, only 50% of people complete long-term therapy for chronic illnesses as they were prescribed. According to the US government's Office of the Inspector General, research indicates that 55 percent of the elderly do not follow the medication regimens prescribed by their physicians.
As described in my post of August 10, 2010, Don't Ask, Don't Tell, I had an exchange with another psychiatrist that included the following:
Me: Family members will not usually volunteer the whole truth during a superficial visit with a doctor. Anyone who thinks that family members act the same way at home as they do in front of an authority figure, or that they will be totally honest about things like family violence or abuse, needs to get out more.
Other Psychiatrist : This broad statement essentially implies and equates pediatric mental disorders with the family abuse and neglect... The reasoning goes along the line "if child has problems, someone in the family caused them." And if the family does not offer any evidence of maltreatment,they are lying. A fundamental fallacy, in my opinion, that for decades prevented psychiatrists from understanding the nature of mental disorders... Suspecting family members of hiding "the whole truth" is a regrettable statement from a professional.
It sounded to me like it is the writer who is saying that poor discipline or even child abuse is never an issue in any behavior or psychiatric problem at all! And apparently he believes patients never fib or hide information! And the statement about offering evidence of maltreatment? First, that implies that this psychiatrist probably never even asks about it in the first place but waits for the parents to "offer" evidence. And since we were talking about children, if the parents had been abusive or neglectful, does anyone think that they would admit this to someone who was legally required to turn them in to the authorities? REALLY?!?
I pointed out in that last post: Obviously this psychiatrist has never done any serious psychotherapy, or he would know that a patient may not reveal absolutely essential information about their situation until they have been seeing a therapist for months.
Going back to survey that is the subject of this post, the reasons that the subjects gave for not being truthful to their doctors were very instructive. Although males often withheld or altered the facts due to a fear that the doctor would recommend that they take sick leave or quit their job, the two most common reasons given for lying to the doctor were:
- The patients found it difficult to talk to their doctor, particularly about things they were ashamed of or embarrassed about (49%).
- They thought that the doctor would not take it seriously, even if they they told him or her (36%). In particular, females said they could not trust their doctor or that "he looked busy."
Furthermore, researchers do very little to establish a trusting therapeutic relationship with their subjects. Many do not know how to establish this type of relationship, but even if they did know how and really wanted to try, doing so would increase the placebo response rate and should therefore not be done in a so-called empirical study!