Apparently, there are some legitimate reasons why a patient may lie to their physicians.
A recent article in the Los Angeles Times discusses the phenomenon, which as Dr. Gregory House would aptly summarize as, “Everyone lies.”
In fact, a recent survey suggests that “38% of respondents said they lied about following doctors’ orders and 32% about diet or exercise.”
One interesting reason is that patients are wary disclosing potentially damaging information to health insurance companies. Indeed, when patients apply for individual health insurance, their medical record is pulled up. And since trivial details can cause insurance companies to deny health coverage, patients certainly may have second thoughts about giving an accurate history.
Furthermore, “when processing a claim, the insurance company finds something in a patient’s records that contradicts something the patient said when purchasing the policy, the company can retroactively cancel the policy.”
That’s pretty harsh.
But making medical decisions on inaccurate information have consequences as well, including providing poor patient care.
One suggested option would be to maintain two sets of medical records, one that is shared with the insurance companies, and a private one that is not released to third parties. Some patient advocacy groups even go as far as saying, “If your physician won’t do that, it’s reason enough to leave the physician.”
I currently don’t offer such an option. I wonder how many other practices do.
Related posts:
- Banning balace billing is tantamount to single-payer
- How much access should patients have to their medical record?
- Data entry in EMRs, and why doctors are slow to adopt information technology
- Patients die when doctors don’t talk to one another
- Op-ed: Why doctors still balk at electronic medical records
- Doctors and patients need to learn to live with health insurance companies
- Should patients own their medical records?
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Kevin,
Is that “legal” or whatever the term would be to describe this activity. I was under the understanding that patient confidentiality was pretty much nil if placed in a record and the insurance company wanted it; at least the payor of the patient’s healthcare benefits. I guess logically if another third party asked then you could choose what information to release, but if evidence came about later, could the physician be liable for “withholding” information.
That’s why as a doctor I don’t sign contracts with commercial insurance companies. Some of my more privacy-oriented patients also choose to see me because my practice is “off the grid.”
One of my patients (21 yr-old male, on public assistance, bipolar disorder well controlled on lithium, no other health problems) applied for individual coverage through Kaiser Permanente and was rejected. His rejection letter stated, as a reason for denial, “You have visited a medical professional’s office within the last 12 months.” Maybe I should have charted that he was just stopping in to say “hi.”
Because individual future medical costs are highly predictable based on existing conditions, it is not surprising that the model of insurance as risk sharing is breaking down in medical insurance for the individual market (as opposed to group policies for groups not self-selected for the purpose of buying medical insurance). Medical insurance is really more like prepaid medical expenses in many cases (obviously, there are injuries from car crashes, tripping on the sidewalk, etc. and occasional infectious diseases, but those seem to be small overall compared to long term care of chronic conditions).
Here is another. If your doctor has mandatory reporting as we have in Pennsylvania, the patient in a rural setting may lose his driving license and ability to get to work.
I am suing the Commonwealth of Pennsylvania in Federal court to overturn this crazy interference with the statutorily protected and constitutionally based right to a confidential doctor-patient relationship.
The complaint may be read here:
http://davidbeharmdejd.blogspot.com/2009/06/complaint.html
Physicians cannot function if patients have to choose between candor and their jobs.
Does this have implications regarding the proposed government-mandated EMRs?
Vickers:
Very much so! Doctors and patients gave up a whole lot when the latter decided to promote health insurance because they didn’t want to be troubled with the collected and the latter because they didn’t want to bother with saving for a rainy day.
Only a remnant of the doctor patient relationship remains. The only way to restore it is to do the opposite of what the current direction is–to move towards less insurance and more self-insurance.
This is where the erosions of the doctor patient relationship and the bad medical care that results gets translated into real objective terms: People are motivated to lie to their doctors. The insurance companies understandably see them doing so (and doctors doing it for them) as contract fraud. But as pointed out before, the insurance model is breaking down because with more knowledge about disease it is less and less an unforeseeable catastrophe and more and more a predictable expense. As their ability to exclude those who are actually at enough risk to need the coverage gets better, the motivation to lie gets higher. If insurance is mandated, then it actually becomes completely morally justifiable, as the contract is no longer voluntary. Slaves and subjects of tyranny must lie to protect any shred of liberty and privacy.
Expect a lot more of this. I was stuck by an article by a psychiatric colleague a few years ago who works for the state department. Free of state medical practice laws which require the keeping of medical records, he protects his patients–the elite ruling employees of the very government which is making serfs of the rest of us–by keeping no records at all.
A violation of medical practice acts, but probably the only way to fully honor our Hippocratic Oath today
“because they didn’t want to bother with saving for a rainy day.”
This is really great. It’s been raining in my life for quite some time. My most recent rainstorm has produced bills $8000 in medical bills this year and it’s only June. With lost work, transportation, etc…where am I supposed to get the money for this rainy day fund? I don’t make a 6 digit yearly salary like you do. Of course, I could forgo medical care…I think the probability that I would die of my medical problems without treatment is low. At least herbs are affordable.
I won’t speculate on whether I “should” lie to my doctors, but I do.
The main thing I do is dumb down. There are doctors who are suspicious or defensive about patients who seem to be too interested and informed, and in those cases I don’t feel I will get good care if they become aware that I know PubMed or even sciencedaily.com exists…instead it’s “oh doctor, I read this in a “6 things your doctor won’t tell you” article in a magazine, can you tell me if it’s true…” Also if a doctor is hostile about some activity in my life (usually weight training), I’ll nod along dumbly as I get lectured, but change nothing.
I used to keep stickies in my paper charts for those little “tidbits” patients told me that I thought should be kept out of their record – personal things that affected how I might manage her care (ie., husband having an affair – think about STD’s, a positive BRCA test in the setting of a strong family history that justifies her care anyway…). But now with the advent of the EMR I find there is no place to hide.
One could also argue that if the insurer is paying for the care they have a right to know everything. And yet, colleges no longer are allowed to share grades with parents, even though they are the ones paying for tuition. Guess parents need a stronger lobby….
Of course, patients are not always truthful with us. i suggest that we sometimes ‘massage the truth’ as well when we are advising them. For example, how do we package our advice when we are recommending chemotherapy, a catheterization or a colonoscopy? While honesty should not be a relative virtue, we physicians often speak in shades of gray. http://www.MDWhistlelblower.blogspot.com
In psychiatry, we’ve been doing this for decades already. Psychiatrists very often have 2 sets of charts, with one discoverable by HIPPA, insurance companies, and the patient themselves, and a second set of private notes which are owned and kept by the doctor.
The second set (in classical analytic therapy) is often a description of the countertransference the doctor has towards the patient, and so could be harmful to the process of the therapy if brought out too early.
In some states, the second set of private notes are not discoverable in a subpoena (unless it’s for a criminal case), so they are protected from law suits as well.
“One could also argue that if the insurer is paying for the care they have a right to know everything”
As an employee of a large health insurance company that gets group insurance through the same, this has always been particularly troublesome. Apart from that, one helpful customer service rep didn’t hestiate to notify me that she had the same disease that I did when she looked at the screen, even though I was calling about a dental billing issue for a different family member.
Third party contracts permit them access to your records. Keeping alternate records is illegal and all sets are legal documents. If you don’t like the fact that insurance has access to it, you have one recourse. Pay cash for your illness and/or don’t contract with insurance.
I’m one of those patient advocates who counsels patients to be honest for the sake of their health AND their relationship with their doctors.
That said, as long as payers are allowed to deny coverage for pre-existing conditions, patients may be wise to continue withholding the truth from their doctors.
Once again, the real loser in the dysfunction of the American healthcare system is the patient.
I am one who always believed in being totally honest with doctors.
But this was before I realized that disclosing a psych med history tends to result in not being taken seriously and thus leading to bad care.
Because I am now down to a very low dose of one psych med (I intend to be off eventually), I will not be disclosing anything about that history when I settle on a new doctor. I will be getting health insurance so that is why I need someone new.
I am not at all comfortable being less than honest. But then there is reality.
Sometimes patients lie about their sexual orientation because they think their doctor (or their pharmacist) will become hostile or refuse to see them any more. Fear can be a real problem in areas with few health care options.
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