Jan 10, 2009

Health - What we lie to Doctors about and why it matters

Joan Raymond

There are big lies. And little lies. And somewhere in between there are the lies we tell our doctors. Even back in the day, Hippocrates, the father of modern medicine, knew that those pesky Greek patients might tell a fib or two. To find out if they were stretching the truth, Hippocrates measured their pulse rates.

Janie Hoffman's doctor didn't have to do that. During a routine visit, Hoffman's doctor asked her if she was still smoking. Hoffman said, "No, I quit." Her doctor then looked at her and said: "I guess that pack sticking out of your purse is for a friend." Still looking for an out, Hoffman replied: "How did that get there?" It would have been smarter for Hoffman to suffer the embarrassment and 'fess up. It may be painful, but telling your doctor about your questionable health habits like eating vats of junk food, or talking about socially risky behaviors like overindulging in alcohol, illegal drugs or unprotected sex, could save your life.

That's not always obvious to patients who sometimes feel that telling a fib, or omitting information, can be less angst-inducing than listening to a diatribe about the dangers of certain lifestyle choices. "I'm not stupid and everyone knows that smoking is bad, but who wants to hear a lecture?" says Hoffman, a Los Angeles marketing executive who kicked the habit (honestly) not long after that visit and has been tobacco-free for more than five years. Apparently, not too many of us. According to survey done by WebMD, Hoffman is among the 13 percent of 1,500 respondents who actually admitted they lied to their docs. Thirty-two percent only admitted they "stretched the truth," which is a lie by any other name.Our lies cover the gamut. Nearly 40 percent of folks lied about following a doctor's treatment plan, and more than 30 percent lied about their diet and exercise regimens. Folks were also not truthful about smoking, risky sex, alcohol intake, recreational drug use, taking medications as prescribed, second opinions, and the use of alternative therapies and supplements, among other things.

Not telling your doctor about all the health products you're taking, even if they seem innocuous, can be particularly risky. A study that appeared in the Journal of the American Medical Association in December shows that about one in 25 adults between the ages of 57-85 are putting themselves at risk for major drug interactions when mixing prescription drugs, such as a commonly prescribed blood thinner, with over-the-counters like aspirin, vitamins and supplements, such as the popular ginkgo biloba. "Patients have to come clean about the various things they put in their bodies," says Dr. David C. Thomas, associate professor of medicine, at New York's Mount Sinai School of Medicine. "We ask questions for a reason."

Doctors believe that most patients don't walk into their offices intending to lie. But they know that fear of judgment, the desire to appear to be a good patient, a lack of understanding about why certain questions may be asked, and even insurance worries, often lead them down the path of duplicity.

And when it comes to fibs, doctors have heard it all. "The classic is that a lot of patients will underestimate the number of sexual partners they've had," says Dr. Deborah Lindner, an OB/GYN at Northwestern Memorial's Prentice Women's Hospital in Chicago. She concedes that "after a certain number" that particular lie doesn't "really matter that much," but women who deceive themselves and don't practice safe sex, for example, run the risk of sexually transmitted diseases not to mention problems with fertility. "No one wants to admit to risky sex, or having multiple partners, or smoking, or drinking too much," says Lindner. "But people must understand we ask these questions not because we are judging someone, but to keep them healthy."

These little lies can have consequences from not giving your physician the tools to work with you in preventing disease to sometimes unnecessary testing or changes in medications. If, for example, you tell you doctor you are taking your medications as prescribed, but you aren't, and your blood pressure is still off the charts, that can lead to increased dosing or changes in medications. Or if you continue to gain weight, despite swearing that you are dieting and exercising, doctors "are going to have to look for a cause," says Mount Sinai's Thomas. "That means increased costs and a lot of wasted time. All you have to do is tell us what is going on."Don Martelli of Revere, Mass. hopes he keeps his blood pressure in check and his weight under control. Martelli is a self-described "big guy on a diet." "I like to say I'm on the see food diet; I see food and I eat it," says Martelli, 35, who is 6 feet 2 inches tall and at one time tipped the scales at about 280 pounds. Martelli had borderline high blood pressure and was told to diet and exercise. He admits to telling the little white lies about his lifestyle when he wasn't losing weight. But he was always uneasy. "I thought that maybe my doctor would think I had some weird thyroid thing going on and I would have to get tests," he says. "But I was too embarrassed to say I was face first in a pasta bowl when everyone on the planet is exercising and sipping bottled water."Fortunately, Martelli got a reprieve. At his last check-up, he did drop some pounds and his blood pressure was normal. "I think my doctor knew I was fibbing about some stuff," Martelli says. "But at least he worked with me."

And now technology may make it easier for them to learn the truth. The Cleveland Clinic, along with Microsoft HealthVault, started a pilot program in November with some 400 patients who had heart disease, high blood pressure and diabetes that may keep folks from fibbing—and allow doctors to intervene earlier when blood pressure, blood glucose or weight get out of control. Rather than keeping a log with pad and paper, patients use computer-aided home monitoring equipment to take daily blood pressure, glucose and weight readings that are then transmitted right to their doctor, making it a little harder to fudge the numbers.

Even without computer monitoring, most doctors probably do know when patients are fibbing about common vices. After all, there is that old medical saw that doctors multiply things by two or three. So if you say you have a drink a day, there's a good chance your doctor is already upping the count. But as savvy as a physician might be, a wink and a nod isn't the best way to go about getting good care. "It's really not about [the doctor] building in multipliers or stigmatizing issues, rather you should be able to trust your doctor enough to tell him anything," says Dr. Robert Arnold, director of the Institute for Doctor-Patient Communication at the University of Pittsburgh School of Medicine.

All that honesty takes motivation by the doctor and the patient. For cardiologist Dr. Kim Eagle, motivating his patients to stay on the straight and narrow certainly includes those honest chats about lifestyle and good health. But if good health isn't enough of a reward there's always money. "I'll give my patients a nickel, a buck, if they lose weight," says Eagle, who then tells patients to tape the money to the refrigerator. "People love it. It's a game and it gets conversations going about how we can work together." And Eagle says, those conversations can reveal a lot more about a patient's health than a simple yes or no answer. "If you actually take the time to talk you might find out the reason a patient isn't exercising is because his back hurts, or the reason a patient isn't eating fruits is because she can't afford them," says Eagle, a professor of Internal Medicine at the University of Michigan Health System.Finding time to talk can be tough. It's no secret that the economics of medicine has chipped away at the art of medicine as doctors struggle with the realities of a reimbursement system that demands they see more patients."There's good data that doctors don't do a good job of listening, sometimes cutting off patients within 20 seconds of their opening line," says pulmonologist Dr. Jeff Rabatin of the Mayo Clinic in Rochester, Maine. Rabatin, who has codirected communication skills workshops and has written about the subject, says that doctors can learn how to effectively talk to their patients. But patients have to get with the program, too. "Try to tell your doctor the whole story," Rabatin suggests. And remember, it could be "tough for a doctor to lose weight, too."

The first step in trying to be a more honest patient is finding a doctor that you are comfortable with. And remember that nothing will surprise your doc, including tales about cosmo-bingeing, pot-smoking weekends. "We aren't here to render moral judgments," says cardiologist Dr. Amy Tucker, associate professor of internal medicine at the University of Virginia Health System. "So the half-truths really aren't necessary."Terry Buchen, a golf agronomist from Williamsburg, Va., doesn't lie to his doctor. He plies him with golf balls and golf instructional videos. Buchen is on the road about 200 days a year, flying across the globe to help with turf issues at some of the world's most famous golf courses. He has a tough time with diet and exercise when he's on the road. But he and his primary-care physician, whom he has been seeing for more than 10 years, have developed a good relationship. "When my doctor asks me how he can help me reach my goals, that means a lot," Buchen says. "It makes me feel that I can admit when I fall off the food-and-exercise wagon."But Buchen isn't a saint. He has a told a few whoppers in the dental chair. "I really don't floss as much as I say," he admits. Trust me, Mr. Buchen, your dentist has already figured that out.

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