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How Can We Be More Honest in the Exam Room?

Kelsey Tyler

No matter how honest you are in everyday life, chances are you’ve told a lie in the exam room. Maybe self-medicating with CBD didn’t seem relevant to your visit, or you feared a lecture if you admitted that walking the dog is your main form of exercise. Or you reflexively shook your head no to a question about smoking because, c’mon, you’re not a full-fledged smoker. Regardless, you’re not alone.

In two recent surveys of more than 4,500 adults, researchers found that 60 to 80 percent of respondents have not been completely transparent with a clinician at some point. “It’s hard for any patient to admit things they might not be proud of,” says lead study author Angela Fagerlin, department chair of population health sciences at the University of Utah and a Veterans Affairs research scientist. “But if your goal is to be healthy, it’s usually best to admit what you’re hesitant to say.”

Patients omit information and twist details about their health habits for different reasons. Here are some of the more common reasons for those white lies — with expert insights to help you stay honest during your next appointment.

You don’t want to be judged

Among survey respondents, the most common reason for lying to a doctor was a fear of being judged or lectured. That’s precisely why Mike Robinson, 53, a blogger in Santa Barbara, California, says he failed to disclose his medicinal use of cannabis oils to a new oncologist.

Robinson was only seeing her for diagnostic work, as he’d decided to fight his cancer with cannabis and decline other treatment recommendations. Still, he suspected the oncologist would judge his nontraditional treatment plan and push him to try chemotherapy, so he filled out his patient intake form without mentioning his physician-prescribed THC oil.

Robinson’s seemingly minor omission had a snowball effect. One thing led to the next, and he wound up with a 30-day coverage suspension for treatment noncompliance. If he’d explained at the outset that he did have medicine, albeit not the traditional kind, Robinson says, he would have avoided the insurance drama: “Had I just filled out the intake form without that omission about what I was using for medicine, things would have gone smoothly. Very simply put, lying to your doctor only hurts you.”

“It’s human nature to try to look good; therefore, it’s very easy to withhold information that we [perceive] as negative,” says Setareh Alipourfetrati, a resident physician at Mount Sinai St. Luke’s hospital in New York City. “But your doctors are only as good as the information they have. By holding back details, you’re cheating yourself.”

With the rising use of shared electronic health records systems, seemingly minor lies can stick with you over time. “The data that you are not truthful about or hold back might be assumed as accurate by your future providers and in different settings,” Alipourfetrati says.

Think of your physician like a mailman, she suggests: “You don’t give the wrong address for your mail delivery just so that the mailman thinks you live in a better neighborhood. What you want is for your providers to deliver the best medical care tailored to your needs. To do that, they need to know you and your needs.” Medical professionals can help patients by creating a trusting and equal environment in the exam room. “I also always encourage and thank patients who [disclose] difficult-to-share information and tell them how helpful it is for me to know the truth,” she adds.

The idea that patients conceal unflattering details to skirt judgment is supported by psychological research. As social psychologist Lauren Howe explained in a piece for The Paper Gown, her work suggests that many patients view doctors as judgmental because they assume healthcare professionals are beacons of healthy living. But that’s not the case: On average, doctors are in pretty average health.

In the end, keep in mind that providers want to help. They’re asking questions to gather information, not to rate you. As Fagerlin puts it, “They see a whole spectrum of people and spend their time thinking about how to make you the healthiest you they can.”

You’re embarrassed

Our bodies do weird things. It can feel awkward or downright mortifying to tell a healthcare provider about incontinence or painful sex, or any number of health issues we’d rather keep between us and our browser histories. It’s probably not surprising that, according to the surveys, being embarrassed is the third most common reason for keeping doctors in the dark. 

But even if you can’t bear to look your physician in the eye as you describe that disconcertingly fragrant rash, try to remember that doctors see patients with all sorts of conditions all day long. “There is nothing they haven’t seen, so it’s unlikely they would be fazed by your symptoms,” says Ryan Howes, a clinical psychologist in Pasadena, California. “They want to help, but if they can’t see [your issue] or don’t know about it, then they can’t help.”

If the prospect of openly discussing a problem makes you nervous, Howes suggests explaining that to your doctor: “‘Something like ‘I get so nervous at these appointments and have a hard time talking about my symptoms’ is likely to be met with words of understanding and reassurance from your doctor.”

If you really don’t want to talk about something during an appointment, tell your doctor you don’t want to answer that question today.

You could also write down your symptoms or concerns at home, bring the list with you and simply hand it to your doctor. “Yes, they will probably ask follow-up questions,” Howes says. “But once the main issues are out in the open and you see their concern and professionalism, it will be much easier to talk.”

And if you really don’t want to talk about something during an appointment, Alipourfetrati suggests being upfront. Tell your doctor “you don’t want to answer that question today,” she says. “This will prevent them from documenting inaccurate information or making incorrect decisions. It will also make them realize that this is a sensitive topic for you that they should address tactfully in the future.”

You don’t want to hear the truth

Beverly Friedmann, 30, a website content manager in New York City, told her doctor about most of her symptoms, including joint pain, fatigue, weakness and, despite daily workouts, minor weight gain. But she left occasional hair loss off the list, fearing that something serious was going on and hair loss would be the tip-off. “I worried it could be a sign of something related to fertility,” she says.

Friedmann’s doctor (accurately) diagnosed her with hypothyroidism. The condition was treated, but her symptoms didn’t fully abate. When she still didn’t feel 100 percent better a year later, she finally brought up the hair loss, prompting her doctor to run more tests and discover a vitamin B12 deficiency. “The delayed treatment resulted in other symptoms that were more severe in nature,” Friedmann says. “In retrospect, honesty would have saved a lot of time.”

Sure, it’s scary to find a lump or experience a new type of pain. Howes notes that acknowledging a frightening symptom or condition out loud can make it feel more real. “But you won’t get anything done by ignoring it,” he cautions. The sooner you have an accurate diagnosis, the sooner you can treat the issue.

You’re a people-pleaser

It’s not uncommon for patients to want their doctors to like them, says Fagerlin. “You think you will get better care if you say what you think they want to hear.”

But you’re not there to score points. For the sake of getting the most out of interactions with healthcare providers, try to resist the urge to pad the truth or automatically agree with everything your doctor recommends.

“We have this idea that in order to be the world’s best student or employee, that means top performance or straight A’s,” Howes says. “In the world of medicine and psychology, though, being a great patient means being completely authentic and disclosing everything.”

It’s understandable to regard physicians as authority figures. But you’re ultimately in charge of your health, so think of your doctor as your teammate instead. When you work together, you’re more likely to get the best-suited and most effective care.

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The Paper Gown, powered by Zocdoc, covers health and healthcare with a focus on patient experiences — inside and outside the exam room, before check-ups and after surgery, across all states of health. We strive to tell stories that help patients feel informed, empowered and understood. Learn more.