White lies: Doctor-patient relationship key to honestyMOORHEAD – A little white lie to a “white coat” can lead to big repercussions when it comes to your health. When patients don’t tell the truth to their physicians, it can cause medication interactions or an improper diagnosis, says Dr. Allan Luistro, a physician at Minnesota State University Moorhead’s Hendrix Clinic and Counseling Center.
By: Anna G. Larson, INFORUM
MOORHEAD – A little white lie to a “white coat” can lead to big repercussions when it comes to your health.
When patients don’t tell the truth to their physicians, it can cause medication interactions or an improper diagnosis, says Dr. Allan Luistro, a physician at Minnesota State University Moorhead’s Hendrix Clinic and Counseling Center.
“It leads to increased costs for care and possible wasted time of evaluating things further that didn’t need to be done if the patients were being honest,” he says. “But, I believe patients don’t go out of their way to lie to us.”
Patients don’t always think of it as lying, according to an online survey by WebMD. Only 13 percent of respondents say they’ve lied to their doctor. However, nearly a third admitted to having “stretched the truth” with their health care providers.
Luistro, who mostly works with students on campus, says as a whole, he thinks people are honest, especially the student population.
“We find that our students tell us more than even what we’re looking for,” he says.
Dr. Mathew Stayman, a family medicine practitioner at Sanford Health in East Grand Forks, Minn., says he never assumes a patient would lie, but he has a hunch about why people might feel uncomfortable telling the truth. Some people might lack a strong doctor-patient relationship and fear judgment.
“People need to understand that doctors aren’t there to criticize, granted you have doctors who can be abrasive,” he says.
It can take time to find “the right fit,” Stayman adds, but it’s worth the search.
If a physician is overly critical, a patient may not come back or go to anyone else at all, he says.
Penni Weston, a nurse practitioner with Essentia Health in Fargo, says establishing a relationship with a primary care provider is more important than ever.
For convenience, people will go to walk-in clinics, where they’ll likely see someone different every time. The physicians won’t know the patient’s history as well as a primary care provider would, Weston says.
“They’re going to feel more comfortable discussing uncomfortable topics as well as feeling not judged,” she says.
Luistro agrees, saying that the first step of being an honest patient is finding a doctor who puts the patient at ease.
“We aren’t here to morally judge our patients. We’re really concerned about their health,” he says. “If they can be honest with us, then it’s a win-win situation.”
When patients aren’t totally honest, problems arise. For instance, if a 35-year-old woman lies about her smoking habit and she’s prescribed birth control, she could develop blood clots, Sanford’s Stayman says.
The worst issues to lie about vary by age group, he says, but anytime a patient isn’t telling the truth, it can lead to problems.
Diet, exercise, smoking, sexual practices, alcohol use, and illicit and prescription drug use are some of health care providers’ top concerns. What physicians are told about each topic guides how they care for patients, says Audrey Eckes, a nurse practitioner at Fargo Cass Public Health.
If physicians suspect a patient might be excluding facts or symptoms, they may modify treatment. For example, if Eckes is worried a patient might have an alcohol problem, she’ll tweak treatment to be topical if possible.
“If someone isn’t disclosing information, we may not order the right tests, or if they’re over exaggerating, we could end up doing more than what’s necessary,” she says.
Again, Eckes says the problems can be remedied with an open, honest doctor-patient relationship, and that ideal doctor-patient relationship is different for each person.
Some people don’t want to spend much time in the doctor’s office, and they prefer a direct, efficient physician. A more sensitive person might appreciate a physician with a softer approach. Either way, the ideal relationship is a team effort, Eckes says.
“If you’re seeing someone who you feel is judging your behavior, it’s hard to be honest. At the same time, as a provider, you don’t want to ignore high-risk behaviors,” she says. “It’s kind of a give and take. Ideally you should be able to talk to them honestly.”
Honesty is one of a patient’s responsibilities, and asking questions is one of the health care provider’s responsibilities, Essentia’s Weston says.
“If they aren’t honest with us, we can’t help them,” she says.
If the relationship just isn’t working, Eckes says it’s OK to request a new provider. She suggests asking friends and family who they recommend or calling to schedule an appointment with a different physician.
Besides finding the right physician, Eckes says patients also have to be ready to accept their doctor’s recommendations.
People might omit information or say they’re taking their medicine, exercising, etc., because they aren’t ready to change, she says.
“Sometimes it takes a while for people to be willing to make changes. If you alienate them right out of the gate, sometimes you lose an opportunity to affect positive change over time,” Eckes says.
All four providers agree that the key to patient honesty and successful health care experiences is a positive doctor-patient relationship.
“It’s kind of that art of medicine where you build that rapport between doctor and patient,” MSUM’s Luistro says. “It’s not just asking that single question of ‘So you’re taking so and so medicines three times a day’ where they can answer yes. It’s asking several questions so that the patient is involved.”
Tips for getting the most out of your doctor visit
Time is valuable, especially in the doctor’s office.
Many physicians – 30 percent – spend between 13 and 16 minutes per patient, according to a 2013 report by Medscape from WebMD.
How can a health care consumer get the most out of a visit? We asked local providers for tips to help patients maximize their time in the doctor’s office.
• Bring a list of medications, supplements and other therapies.
It’s important for health care providers to know everything a patient takes so they can prescribe new medications that won’t interact, says Penni Weston, a nurse practitioner with Essentia Health in Fargo.
Better yet, she likes patients to bring in the actual prescription bottles, especially elderly patients. That way, she can see exactly what they’re taking, the dosage and the other ingredients in each item.
Bringing a medication list can also open the door to discussion about proper medication usage, cost and alternative therapies, Weston says.
• Be on time.
Time is so crunched that when patients come in late, they lose valuable time with their provider, says Audrey Eckes, a nurse practitioner at Fargo Cass Public Health.
• Speak up during scheduling.
Schedulers block off a provider’s time based on a patient’s needs, Eckes says.
For instance, if a person says they need to see their doctor for a sore throat, the scheduler may not block off a lot of time.
If the patient also wants to have their heartbeat checked or a breast lump examined, it likely won’t happen that visit due to time constraints, she says.
“It’s helpful to tell them there’s more than one thing you want to address,” Eckes says.
• Ask questions.
“Don’t feel that you’re asking dumb questions,” says Mathew Stayman, a family medicine practitioner at Sanford Health in East Grand Forks, Minn.
“Every question is important. It could really change a person’s life by the way you answer it,” he says.
Post-visit questions are welcome, too, Weston says.
“Be informed. We’d rather people call back and clarify than go ahead and just do whatever they think,” she says.
• Don’t be shy.
Health care providers have seen it all.
“It’s pretty hard to surprise us,” Eckes says. “We see all kinds of things.”
She says patients shouldn’t be worried about being judged or embarrassed by anything going on with their health.
• Honesty is the best policy.
“I think really people fear judgment and therefore omit information or mislead information,” Eckes says. “It’s very difficult to adequately care for someone when you don’t really know what’s going on.”
Stayman agrees that honesty leads to proper care.
“This is about your health. This is what you need to do to take care of yourself. This is a closed door,” he says. “They (patients) need to have trust and security with their physician.”
Readers can reach Forum reporter Anna G. Larson at (701) 241-5525