Aug. 29, 2022 — The nurse practitioner called me before my virtual consult with my doctor with a few quick questions. “Have you felt depressed lately?” Nope, I said confidently, even though I’d been white-knuckling this parenting-two-little-kids-during-a-pandemic thing. “Great! That’s what we like to hear!” she replied.
In that moment, I felt proud – She’s so pleased with me! But why was I so quick to tell such a bald-faced lie?
The issue of lying about our health runs deep. Truth be told – no pun intended! – medical and health lying take multiple forms and they have different motivations and consequences.
Harmless Fib or Serious Problem?
A lot of us hide things during medical appointments, says Angie Fagerlin, PhD, population health sciences professor at the University of Utah.
“From our research, we know people aren’t telling their doctors the truth,” she says. Fagerlin and colleagues have published two papers about the phenomenon, with one more forthcoming about our COVID fibs.
One study, co-authored by Fagerlin and published in JAMA Network Open in 2018, analyzed survey responses from over 4,500 U.S. adults and their honesty surrounding common questions on their health habits, medical treatments, and experiences with their provider.
Most commonly, people admitted to lying to their provider when they either disagreed with their treatment recommendation or even when they didn’t understand what the doctor was saying in the first place.
Other reasons? They weren’t taking prescription meds as directed, didn’t exercise, ate an unhealthy diet, or were popping someone else’s prescription.
So why weren’t people fully fessing up?
“The number one most common response from 82% of patients is that they didn’t want to be judged or lectured about their behavior,” Fagerlin says. What’s more, 76% said they didn’t want to know that what they were doing was harmful, while 61% said they were embarrassed. Some patients even said they also didn’t want to come across as difficult or take up more of the doctor’s time.
Another study from Fagerlin and colleagues, published in 2019, analyzed disclosure of extreme and sometimes life-threatening challenges, such as depression, suicidal tendencies, abuse, and sexual assault. One quarter didn’t tell their provider largely because of embarrassment, fear of being judged, not wanting to pursue help (e.g., see a therapist), trying to avoid it being included on their medical record, or assuming their provider couldn’t help.
But this is counterintuitive – and counterproductive: We actively seek medical help and then actively prevent our physicians from providing proper, comprehensive care because we’re concerned about how we’re perceived.
Fagerlin agrees it can be mind-boggling, but it’s common.
“People tend to respect their providers and want them to think well of them. They don’t want to do something to harm that relationship or perception,” she says.
Meanwhile, your doctor won’t know to change your meds if you’re having problems, won’t know to look for drug interactions if you’re taking someone else’s prescription, or won’t be able to refer you to a mental health professional if they don’t know you’re struggling, Fagerlin says.
It’s not like we don’t want to be truthful. Quite the opposite. Research shows that people are willing to be open and honest, particularly about their mental health, when they thought they were talking to an online bot run by a computer, according to past research in Computers in Human Behavior.
“People shared more about their symptoms with the computer when they thought that there was no human involved compared to when they thought they were speaking with a person over technology,” says Gale Lucas, PhD, a research assistant professor at the University of Southern California.
Again, fear of being stigmatized or having a doctor think negatively of you were what fed the fibs, Lucas says. A computer won’t judge you, and we find that more comforting than being face-to-face with someone who might.
There’s Lying … and Then There’s Lying
Sometimes falsehoods go over the edge. These are the reports we often hear about people making up cancer diagnoses, repeatedly checking into hospitals, or self-inducing medical problems. Factitious disorder (once called Munchausen syndrome) is a mental illness in which one “feigns, exaggerates, or self-induces a medical problem in order to get attention, care, or concern that they feel unable to get any other way,” says Marc Feldman, MD, clinical professor of psychiatry at the University of Alabama and author of Dying to Be Ill.
About 1% of patients admitted to general hospitals are faking their symptoms, making it uncommon but not rare, Feldman says. Still, most in this group are those with stable jobs and relationships with loved ones and lie in this way off and on “when they can’t cope with the stress in their life and they need sympathy,” he says.
Having a high-status health care professional hang onto your every word is satisfying and brings a hint of belonging. And generally speaking, doctors are not taught to question patients, he says. Sometimes this sympathy can be gotten from family, friends, or fellow members of the community, and that can be sufficiently satisfying so that they don’t have to seek out a doctor at all.
Fewer people with factitious disorder make up this web of lies chronically, but some do, and weaving medical lies becomes a way of life.
“There are varying motives, but in my experience, the search for nurturance is number one. Others feel as if they don’t have control over their own lives, and manipulating professionals allows them to feel in control,” Feldman says.
Still, for some, it’s an underlying personality disorder driving chronic deceit. But for others, it’s profit. Some people make big money from their health fabrications, and experience big consequences in the bargain.
A California woman recently received 5 years in prison for wire fraud when her fake cancer diagnosis led to more than $100,000 in ill-gotten crowdfunding donations.
And earlier this year a writer for the TV show Grey’s Anatomy lost her job and reputation when her entire medical history – from a rare form of bone cancer to having an abortion while undergoing chemotherapy – was exposed as false. She fabricated all of it to fuel her writing career on the show and in national magazines.
For those who need genuine mental health care, help for factitious disorder is layered and complex, and there is a lack of providers with this type of expertise, Feldman says. Reduction strategies (including distraction when one has the urge to go to the hospital, for example) is one way mental health experts treat this condition, and simply talking to a therapist can help patients come to terms with the fact that their condition is psychological and not physical.
How to Fess Up – Not Fib
Part of the solution is realizing that lying about your health, on some level, provides you with a psychological reward – whether you’re under-reporting your wine consumption for brownie points or awash in sympathy from suggesting to a co-worker you have cancer.
But is that reward worth the consequences?
It can be tough to be vulnerable when owning up to medical truth, especially in a clinical environment where the balance of power seems skewed away from you. But avoiding the tough talks, and – even if they are small – the seemingly harmless fibs, can impact your ability to be successfully treated for a condition or stand in the way of making changes to daily habits that can benefit your health in the long term.
Knowing that you’re apt to lie or not tell the entire truth is the first step.
“Our research suggests that it’s a fear of evaluation that’s driving the choice not to open up. Awareness of that can potentially give you the power to make the difficult decision to share with providers,” Lucas says.
Another possibility: Talk frankly to your doctor about the difficulties, for example, of leading a healthy lifestyle. Most doctors will acknowledge and sympathize with that – “Hey, I know it’s tough to exercise regularly; it’s hard for me, too.” – and it becomes easier for patients to be truthful about their own habits and struggles. When a healthy lifestyle is made the default, almost all of us fall short.
“Going against the default is difficult for humans to do and admit to,” Fagerlin says. But know that “people who go into the medical profession want to help you live your best, healthiest life. They can’t do that if they don’t know the whole story.”
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