Oh, what a tangled web we weave, when first we practice to deceive.

Sir Walter Scott

Marmion: A Tale of Flodden Field

It’s not news that deception is popular. Playing fair and telling the truth are held up as model behaviors, but in reality, our society’s grip on those mores is tenuous. A glance at recent news feeds tells of myriad deceptions from championship chess to walleye fishing to fat bear week voting. Not only do some people unflinchingly cheat others, they also blithely deceive themselves...and often their health care providers.

One study suggests that more than 60 percent of patients lie to their physician or withhold information. Lying about personal behavior or lifestyle choices (i.e., diet, drinking, smoking, sex, drugs) complicates the provider-patient relationship. Whether prompted by embarrassment, ignorance, or defiance, those deceptions can impede preventive or prophylactic care, or muddle the diagnostic process. For patients undergoing treatment for a known illness or injury, dishonesty may put them and their providers at increased risk for an adverse outcome and, potentially, an allegation of medical malpractice.

A successful clinician-patient relationship is built on trust, two-way trust. Patients need to feel safe divulging health-related information and their clinician’s judgment relies, at least in part, on the patient’s candidness. Anything less compromises the care team’s ability to meet the patient’s needs. A clinician who is told (by the patient) that the patient is: taking their medications, avoiding specific substances/activities, and adhering to the treatment plan, incorporates such conveyance into subsequent assessments and treatment decisions. A patient who purposely withholds information about new or worsening symptoms, or personal issues (e.g., losing a job, divorce, insurance issues), accelerates the risk of misdirected or delayed care.

Maybe more than in the past, patients need counseling to understand the importance of being truthful about symptoms, changes in status, actions, or inactions, that might steer their caregivers down an unsafe care pathway. It may be tempting to blame a patient for misdirecting their own care, but a delayed diagnosis or mismanaged treatment that results in serious harm may prompt even a knowingly deceptive patient to bring forth a claim or lawsuit alleging malpractice. Efforts at pre-emptive trust building may help providers avoid the tangled web of deception.

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