Truthful and complete: how to talk to your doctor

mmoran
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Posted: Jun 21, 2018 10:22 AM
The doctor-patient relationship is a sacred trust, literally a life-and-death bond. But recent research found that half of the 3,000 subjects studied admitted that they deliberately lied to their doctors, or withheld information about their conditions. Let me remind you why this should never happen—and what should always happen.

It's all about you

It goes without saying (but I'm saying) that a physician can't properly care for his or her patient using false or missing information. The truth, the whole truth, and nothing but the truth are absolutely essential, down to every last detail—even details that seem trivial or unimportant. Here's a quick example of a health threat that doesn't seem like one—a detail easily overlooked, forgotten, or deemed incidental when a patient discusses diet with his or her doctor.

Danger! Grapefruit?

Yes. In the category food-drug interactions, certain enzymes in delicious, bracing, vitamin-rich grapefruit juice can cause your body to absorb way more of a drug—for example, widely-prescribed blood pressure and cholesterol-lowering statin drugs. Result? An overload of the drug in the body, with the increased risk of side effects, from mild, such as muscle and joint pain, to severe, including muscle fiber breakdown and kidney failure. Grapefruit isn’t alone on a long list of dangerous food-drug interactions, such as combining the anti-clotting blood thinner Coumadin and leafy vitamin K foods that promote clotting. Talk about cross-purposes. There are also combinations that fall into the drug-drug interactions category:
  • Drugs for high blood pressure and OTC nasal decongestants don't mix. The combination can actually raise your blood pressure
  • Tylenol and alcohol taken together can harm your liver
Again, danger?  In everyday decongestants and pain relievers?  Yes—so never assume OTC means "harmless." And always be sure your doctor knows what goes on in your life, down to the last detail.

Be your own best data source

To that end, for every doctor visit, you should have ready a pre-appointment dossier that's all about you—including all the details of your diet, every med or supplement you're taking, and why you've made the appointment, in the first place. Regular checkup? Pain? Insomnia? Joints hurting, stomach misbehaving, vision blurry, unusual or habitual fatigue? Be sure you include information on your physical activity—no matter how insignificant it might seem. If you're sedentary, for example, the extent of your activity is by definition limited.  But that's important! When your doctor knows you're desk-bound or couch- bound, he or she can help get you up on your feet more often, an easy step at a time, instead of leaving you with the vague directive to "get more exercise?" And don't omit any stress factors in your life.  That stuff kills. Even the everyday stuff we all get stressed about—spell it out. And for heaven's sake, don't omit your meds and supplements. You've already seen examples of drug-drug and drug-food interactions. Be assured the lists are far longer and the hazards more consequential than what I've just showed you. To put it all very simply, the more your doctor knows about you, the more he or she can help you.  Help him or her and yourself by preparing. With so much at stake, why, returning to my opening paragraph, in the world would anyone not be fully truthful in helping to manage his or her own health? What's the motive to lie or omit?

Shame, shame, shame

Research has shown us that patients will lie about symptoms in order to qualify for government disability payments, to get a more helpful insurance payment, to get drugs they don’t medically need, or to protect someone—an abusive spouse, for example. Or sometimes they’re just plain embarrassed because they know they should be doing something that they’re not (eating better, exercising more, taking prescribed medications)…or they know they shouldn’t be doing something that they are (smoking, drinking too much alcohol, etc.). That's basically gaming the system, and it's not without risk outside of the therapeutic context, including that legal action. Among patients who are simply interested in their health, research shows that they most often lie about:
  • Drug or alcohol use
  • Diet
  • Sexual activity
Survey respondents said that their own shame, guilt, or embarrassment was behind their behavior, or the expectation that they'd be on the receiving end of a scolding, or a lecture.  Or that "word would get out" about their personal life. I can understand why these are sensitive topics—but not really. There must be no secrets in the doctor-patient relationship, and there's nothing we doctors see or hear that we've not seen or heard before. Nor is there any worry that word would "get out". The only time I’m allowed to share a patient’s medical information is when it’s essential to their well-being and, even then, I can only share it with another medical professional, and only with patient consent. Occasionally I may have to report information on the medical issue itself, but then it would come with no identifying information about the patient—only his or her symptoms, treatments, and outcomes, to date.

It's all about you ... and maybe millions of others?

There's another important reason why patients should always tell the truth and the whole truth. Incomplete or inaccurate information has serious ramifications, both within and beyond each single doctor-patient relationship.  These days, electronic health records (EHR), collected by physicians and clinicians, are sent off into any number of databases, where researchers can detect trends and/or anomalies that can help the entire universe of patients. In other words, a single lie, or some overlooked, unreported information, can have global impact when it's multiplied thousands or millions of times. For example, I read of a doctor who didn’t believe his patients’ ethnicity was important when entering their information into his electronic health record system. So, by default, he labeled them all as Albanian since it was the first ethnicity listed in the drop-down menu on his record-keeping software. Now, if researchers pick up a health trend in this doctor’s California county, it may be skewed since roughly 90% of his patients are listed as Albanian. Make sense?  

So how do we doctors help patients shed their fears and concerns?

Sad to say, we physicians should never just assume that we're getting all of the information we need for patient care.  Nor should we just assume that a patient fully trusts that their information will remain confidential. I believe these issues must be proactively addressed at the start of every contact with every patient, sort of like when a law enforcement official has to read an arrested person his or her rights.  "As your physician, I'm required by law to keep all information you give me confidential and to remove any personal, identifying information about you if your medical history may be used for medical research from your record ... " Like that, only shorter. Still, and an ongoing concern, let's note that research found that 19 percent of patients would be 100 percent honest
if their physicians explained the dangerous consequences of fabricating or withholding information—as I've done in this piece. But only 19 percent? Well, it's at least a hint that we should take positive steps to get that number higher. I'll bet it would help, for example, if all doctors instilled a sense of "patient pride" by reminding them that it's not just their own health on the line—any detail could help millions of others.  I also recommend including the grapefruit story in their conversations with their patients. It's one of the most effective examples of how important seemingly incidental or irrelevant information can be—score points for the power of surprise. One final, important note. Research tells us that other reasons why critical information is missing in the exam room include not having enough time during the appointment, and not being asked enough questions about their symptoms, specifically, and their lifestyle, generally. These factors led about one-third of participants in one study to withhold health details, and point to some changes needed in the healthcare system—not rushing an appointment, and educating doctors to ask more, and more direct, questions. We don't have to wait for those systemic changes to come around. Take good care. References