August 29, 2022 – The nurse called me with a few quick questions before my virtual consultation with my doctor. “Have you been feeling depressed lately?” No, I said confidently, despite getting my fingers all over this thing about raising two young children during a pandemic. “Big! We like to hear that!” She answered.
At that moment I was proud – She is so happy with me! But why was I so quick to tell such a blatant lie?
The problem of lying about our health runs deep. Honestly – no pun intended! – Medical and health lies take many forms and they have different motivations and consequences.
Harmless lie or serious problem?
Many of us hide things at doctor appointments, says Angie Fagerlin, PhD, professor of population health sciences at the University of Utah.
“We know from our research that people don’t tell their doctors the truth,” she says. Fagerlin and colleagues have published two papers on the phenomenon, with another forthcoming on our COVID fibs.
A study co-authored by Fagerlin and published in JAMA network open in 2018 analyzed survey responses from over 4,500 US adults and their honesty to frequently asked questions about their health habits, medical treatments, and experiences with their provider.
Most often, people admitted to lying to their doctor when they either disagreed with their treatment recommendation or didn’t understand what the doctor was saying at all.
Different reasons? They weren’t taking prescription drugs as directed, didn’t exercise, had an unhealthy diet, or took someone else’s prescription.
So why haven’t people fully admitted it?
“The most common response from 82% of patients is that they didn’t want to be judged or lectured about their behavior,” says Fagerlin. Additionally, 76% said they didn’t want to know what they were doing was harmful, while 61% said they were embarrassed. Some patients even said they didn’t want to seem as difficult or take up more of the doctor’s time.
Another study by Fagerlin and colleagues, published in 2019, analyzed exposure to extreme and sometimes life-threatening challenges such as depression, suicidality, abuse, and sexual assault. A quarter told their doctor primarily out of embarrassment, fear of judgment, not wanting to seek help (e.g., seeing a therapist), trying to avoid having it included on their medical record, or assuming they that his doctor could not help .
But that’s counterintuitive — and counterproductive: we actively seek medical help and then actively prevent our doctors from providing appropriate and comprehensive care because we worry about how we’re perceived.
Fagerlin agrees it can be startling, but it’s common.
“People tend to respect their providers and want them to think well of them. They don’t want to do anything that harms that relationship or perception,” she says.
Meanwhile, your doctor won’t know how to change your medication if you’re having problems, won’t know how to check for drug interactions if you’re taking someone else’s prescription, or won’t refer you to a psychiatrist You can refer professionally if they don’t know you’re having problems, says Fagerlin.
It’s not that we don’t do that want be truthful. But on the contrary. According to previous research in Computers in human behavior.
“People shared more about their symptoms with the computer when they thought no human was involved compared to when they thought they were talking to a person about technology,” says Gale Lucas, PhD, an assistant science professor at the University of Southern California.
Again, it was fear of being stigmatized or that a doctor might think negatively of you that fed the lies, Lucas says. A computer won’t judge you, and we find that more comforting than coming face-to-face with someone who could.
There are lies… and then there is lying
Sometimes untruths go over the edge. These are the accounts we often hear about people diagnosing cancer, repeatedly going to hospitals, or creating medical problems themselves. Factual disorder (formerly called Munchausen syndrome) is a mental illness in which one “fakes, exaggerates, or brings about a medical problem in order to gain attention, care, or concern that one cannot feel otherwise,” 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, which is uncommon but not uncommon, Feldman says. Still, most in this group are those with steady jobs and relationships with loved ones, and they occasionally lie in this way “when they can’t handle the stresses in their lives and need compassion,” he says.
It’s satisfying to have a senior health professional hanging on to every word and instills a sense of belonging. And in general, doctors aren’t taught to interview patients, he says. Sometimes that compassion can be obtained from family, friends, or other members of the community, and it can be so gratifying that they don’t need to see a doctor at all.
Fewer people with fact-finding disorder chronically weave this web of lies, but some do, and weaving medical lies becomes a way of life.
“There are different motives, but in my experience the search for care comes first. Others feel they have no control over their own lives, and professional manipulation makes them feel in control,” says Feldman.
Still, for some, it’s an underlying personality disorder that drives chronic delusion. But for others it is profit. Some people make a lot of money from their health fabrications and experience great consequences on top of that.
A California woman was recently sentenced to 5 years in prison for wire fraud when her fake cancer diagnosis resulted in more than $100,000 in ill-gotten gains in crowdfunding.
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 an abortion while undergoing chemotherapy — was exposed as false. She fabricated it all to further her writing career on the show and in national magazines.
For those who need real mental health care, man-made disorder help is multifaceted and complex, and there’s a dearth of providers with that kind of expertise, Feldman says. Reduction strategies (including distraction, for example, when one has urges to go to the hospital) are one way mental health professionals treat this condition, and simply talking to a therapist can help patients come to terms with the fact that her condition is psychological and not physical.
Admittedly – not Fib
Part of the solution is recognizing that lying about your health provides you with some level of psychological reward — whether that’s understating your wine consumption for pluses or brimming with sympathy for suggesting to a co-worker that you have cancer .
But is this reward worth the consequences?
It can be difficult to be vulnerable when facing medical truth, especially in a clinical setting where the balance of power seems to be off you. But avoiding the harsh talks and — even if they’re small — the seemingly harmless lies can interfere with your ability to be successfully treated for an illness or prevent changes in daily habits that can benefit your health in the long term.
Knowing that you tend to lie or not tell the whole truth is the first step.
“Our research suggests that it is the fear of judgment that drives the decision not to open up. Awareness of this can potentially empower you to make the difficult decision to share with vendors,” says Lucas.
Another option: Talk openly with your doctor about the difficulties of, for example, leading a healthy lifestyle. Most doctors will recognize this and sympathize with it – “Hey, I know it’s hard to train regularly; it’s hard for me too.” – and it becomes easier for patients to be honest about their own habits and struggles. When a healthy lifestyle is made the norm, almost all of us fall short.
“Going against the standard is hard for people to do and admit,” says Fagerlin. But do you know that “People who go into medicine want to help you live your best, healthiest life. They can’t if they don’t know the whole story.”