Tuesday, 21 May 2019

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Patients Don't Always Tell the Truth

Sometimes patients withhold information from their doctors, and a new study suggests that as much as 60 - 80% of patients consciously omit information to their doctors, despite knowing this may bear on their health and well-being.

In two national online surveys of 4510 US adults and their self-reported medical behaviors, most participants reported withholding at least 1 of 7 types of medically relevant information, especially when they disagreed with the clinician’s recommendations or misunderstood the clinician’s instructions. The most commonly reported reasons for not disclosing information included not wanting to be judged or hear how harmful their behavior is.

From these 2 surveys we see that most patients were white (79-84%) with mean ages of 36 and 61 years.  Key findings included:

  • 61-81% avoided disclosing at least 1 type of information
  • 46% disagreed with the clinician’s recommendation
  • 31% did not understand the clinician’s instructions
  • 62-82% failed to disclose as they did not want to be judged or lectured
  • 61-76% not wanting to hear how harmful the behavior is
  • 59-61% not wanting to be embarrassed  

Those most likely to withhold information were women (OR 1.38-1.88), younger (OR 0.98), and have worse self-rated health (OR 0.80-0.87).

Other patient viewpoints included: 

  • I didn't want the provider to think I'm a difficult patient (51 and 38 percent)
  • I didn't want to take up any more of the provider's time (45 and 36 percent)
  • I didn't think it mattered (39 and 33 percent)
  • I didn't want the provider to think I'm stupid (38 and 31 percent)
  • I didn't want this information in my medical record (34 and 31 percent).

The authors surmised that the electronic health records may worry some about what goes into their chart.

Withholding important information from their clinicians was most likely when patients disagreed with or misunderstood their clinician’s instructions. A better understanding is needed of patients comfort and fears if we are to improve clinician-patient relationship and patient care.

The author has no conflicts of interest to disclose related to this subject

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