Patient Lies Complicate Treatment, Confound Physicians

January 17, 2011

You know patients lie. No, not all of them, but a significant number do. Often, it's harmless and at most annoying. But sometimes, patient lies not only make it difficult to treat them, it makes it darn near impossible.

You know patients lie. No, not all of them, but a significant number do. Often, it's harmless and at most annoying. "I'm so sorry I'm late, I ran into traffic." Who among us hasn't heard that or even used it? Or "I'm running late but I'm just around the corner and I'll be there in two minutes." Or "I never got the forms you sent."

But sometimes, patient lies not only make it difficult to treat them, it makes it darn near impossible. What do you do with the patient who insists his blood sugars are between 120 and 180 and yet has a hba1c of 12? I've given him the benefit of the doubt and blamed his meter and given him a new meter. I have asked him to check more frequently. I have now had him temporarily hooked up to a continuous glucose sensor. We'll see how that goes.

Then there's the young man with low testosterone who swears he has never taken anabolic steroids, yet has big bulging muscles quite atypical for someone with hypogonadism. His work up has been negative. Even after going over the risks of starting testosterone replacement, he was all gung-ho to start. And now he is trying to manipulate me into raising his dose before we've even started.

And the type 1 diabetic admitted in DKA for the fourth time in 6 months who swears she takes her insulin at home but quickly becomes hypoglycemic in the hospital on half her prescribed dose.

Even insurance companies are "outing" patients. Have you received those letters informing you that your patient hasn't refilled his prescription in 6 months? Or that he is getting narcotics from 3 different physicians?

So what do you do if your gut is yelling "Liar, liar, pants on fire?" What if all the evidence suggests the patient is lying but he looks at you with those puppy-dog eyes and says he doesn't understand why the test results are what they are? Do you call them on it? Do you keep trying to get the truth out of them? Do you try to work around the lie? What is your liability? You have to make decisions with the information you have at hand. What if that information is false? It's a tough call. One I currently make one fibber at a time.