A thin, slightly hysterical twenty-four-year old male presents to the Alfred Emergency and Trauma Centre in Melbourne. He arrives in a panicked state, he’s struggling to breathe, complains of chest pain, he’s sweating and has a pale complexion. He tells the doctor he’d been to a party over the weekend, had a few drinks and woke up struggling to breathe.
The emergency consultant begins his investigation but already suspects either a reaction to an illicit drug, an infection or much less likely a clot in the lung. Despite repeated questioning however, the patient strongly denies having taken any illegal drugs.
The blood tests and the chest X-ray are normal, but the patient’s ongoing symptoms require further investigation. The next stage is to perform a CT scan which rules out the suspected clot. Once the results are all in the young man eventually admits to heavy amphetamine use; all up this lying patient cost the public hospital system six hours and involved ten staff. Furthermore, the patient put himself in danger because he was unnecessarily exposed to radiation.
The exterior of the Alfred Emergency Department, since renamed Eva and Les Erdi Emergency & Trauma Centre. This is the underside of the helipad. Image courtesy Peter Fritz
It appears though that lying is much more common than we care to admit - and apparently, we all do it! And if you say you don’t, you’re probably lying. Pamela Meyer, the author of Liespotting: Proven Techniques to Detect Deception, says, “Lying is as old as breathing.” Our histories are littered with lies; “some lies have changed the course of human history on a grand scale […]” In fact, Meyer says, “Lying begins as early as infancy.”
She also found that most people are lied to as many as two hundred times per day and “strangers lied three times within the first ten minutes of meeting each other.” Scientists also confirmed that, “Lying is in fact one of the major building blocks of human social life.”
However, Meyer doesn’t view ‘white’ lies as problematic; she says we use these lies “to smooth the jagged edges of our social interactions.” It’s the “dangerous” lies that she finds concerning; the ones that influence our decisions with regards to jobs and businesses, close relationships and our personal life.
So, what about our deceitful relationships with doctors? Studies show that in health care, patients regularly withhold information or outright lie. We most commonly lie about how much we drink and smoke. We drink 30 per cent more alcohol than we admit to, smokers regularly lie about how much they’ve cut back, and recreational drug users happily commit bold face lies.
Many liars are simply embarrassed, while others, the serial offenders are known to exaggerate physical or psychological symptoms. One study showed that the rate of these pretender-types or malingerers could be as high as 13 per cent in emergency departments.
Other lying types that pose added challenges to doctors are those with Munchausen syndrome or factitious disorder. These patients are the true attention seekers and are usually very convincing and knowledgeable and are known abusers of the health care system.
Lying however affects information gathering for doctors, a crucial first step that’s necessary for an accurate diagnosis. Dr de Villiers Smit, the Director of the Alfred Emergency & Trauma Centre in Melbourne says,” Doctors can’t really provide optimal care unless they have a good understanding of what’s wrong with a patient. This often includes knowing confronting, humiliating and intimate details about the patient’s personal life; drug and alcohol usage, sexual orientation and practices as well as social circumstances including potential issues around domestic violence.”
Health care professionals are called upon every day to navigate through this complex human experience. Melbourne-based general practitioner, Dr Jill Spargo, with thirty-four years of practice says, “Patients are often embarrassed or ashamed about all sorts of things, and they worry that they might be judged.”
Image courtesy Dr Jill Spargo
She says, “Some patients would rather lie than be forthcoming about things like their medication use, condom use and mental health issues. And sometimes patients have amazing stories and highly sophisticated presentations in order to receive pain medication; they’ll say they have renal colic or kidney stones and writhe around in agony.”
Social scientist and research professor, Dr Brené Brown, explains that shame is in fact the strongest emotion that underpins lying. “Shame is the intensely painful feeling or experience of believing that we are flawed.”
Shame and vulnerability are part of the intimate arena of health care facilities, but Dr Spargo says that by being understanding and insightful about why patients lie is important too. She says, “I prefer to put patients at ease and probe just a little deeper, and sometimes I uncover important underlying issues.”
Today’s lies however are coming at a cost, adding possibly millions to an already overburdened medical system wasting both time and resources and yet hard data on this is currently unavailable. And while many patients’ lies may indeed be innocent with minimal impact on their treatment some can have serious implications to their health.
Light trails whizzing by outside the Emergency Department. Image courtesy Peter Fritz
