Saturday, January 30, 2010

Is It Okay to Lie to Your Doctor?


It's snowy here in Maryland.

First, let me say that it's never okay to lie to your shrink. Therapy is about having an honest interaction, and a psychiatrist probably can't help someone who is hiding a secret life. This post, however, was inspired by Clink's last piece, Rage Against the Machine where she wails on Electronic Medical Records, in a feeble and failed attempt to engage Roy in a fist fight. There she is a punchin' and he's just skating along oblivious as can be.

Why do EMR's make me uneasy? When I'm in the clinic with patients and I can access their medical records, well, it makes life easier. So why don't I like the whole idea? I talked about some of this in the comment section on Clink's blog post.

With an EMR, it's easier to get records, and any doctor in an institution who treats a patient has access to them (oh, the whole institution has access to them, but only those involved in the patient's care are allowed to "peak"). What if a patient wants to withhold some of their information from certain docs? Is that lying? Is that reasonable? Should that be allowed?
If it's about obtaining prescriptions for controlled substances, it's just wrong. But might there be other reasons a patient would want to control the flow of information?

Let's face it, some docs and some patients don't click. A patient may feel the doctor didn't really listen, saw him much too briefly and jumped to a conclusion without hearing all the information, or was uneasy with the doctor's conclusion. The patient comes for treatment of his headaches, and after a few minutes, the doctor says it's "Stress." The patient wants more tests done, the doc feels it's unnecessary, and the patient would like to get a fresh opinion. Electronic Records may hamper the ability to get a fresh opinion. The next doctor may look at the note and agree with the patient that more testing should be done, or he may see another doc's opinion and go with that. And who knows what the first doc wrote, it may continue to prejudice future care. All sorts of human emotions get tossed in here: What if second doc hates/adores first doc, that may prejudice what side he takes. Any way you dice it, if the question is so much as raised that a patient is malingering or that an illness is factious, medical professionals may shut down.

So how does this pertain to psychiatry? Psychiatric patients are often given sub-par medical care. Their medical symptoms are more likely to be attributed to their psychiatric disorders (and sometimes this is appropriate after a reasonable and thorough work up). Perhaps a patient worries that if he tells a doc he's in therapy, his problems will not be considered as valid. I think this is getting better.

Roy would say that the patient should be involved in the evolution of the record. Maybe Roy should say what he wants to say....

And you didn't really think I was going to say if it's okay to lie to your doc!
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So I'm adding this as a next-day addendum: Talesofacrazypsychmajor left us a comment saying that primary care doc who knew of psych diagnosis felt it had to go on every school form that needed to be filled out (presumably for school, work, camp) and perhaps that's a valid thing to reveal to any institution needing medical information. However, it is an example of how the patient is out of control of their information. This example is obviously not an EPR issue alone, but EPR's make the spread of information easier for better or for worse.

21 comments:

Scream said...

Can you try using a few feminine or non gender specific personal pronouns?

I needed and eventually got bilateral ankle surgery. But only after 2 years of being told that all I really needed and an anti-depressant. I hope things have changed.

I was treated well by my last surgeon, in fact I think he treated me even better when I disclosed my condition to him.

I used to hide it but I got burned bad for it, almost lost my SSDI. I tell every doctor I see now, in case the disability police want to see my medical records again.

HappyOrganist said...

I lied to my psychiatrist once (hey I only saw the guy once). He asked a stupid question, so I lied.
I mean I think asking someone if they carry tension in their body is pretty stupid question. Don't you think so? Anyway, that isn't what I went to see him about, so of course I said 'no' to that question.

talesofacrazypsychmajor said...

I just wrote a post about withholding info from my doctor.
http://talesofacrazypsychmajor.wordpress.com/2010/01/27/primary-care/

Basically I don't feel comfortable giving my primary care doc my psych history. I had a previous primary care doc who had all the info and then whenever there was a form for school, or a job or anything she felt ethically obligated to give way more psych history in it than I felt comfortable with. If my doctor doesn't know about it she can't write it down on a form.

Dinah said...

I put my comments on the body of the post at the bottom.

Battle Weary said...

I used to think I had a wonderful GP...now I'm thinking she's not wonderful, but rather, she is FANTASTIC!!! I did not disclose to my GP that I am in therapy or that I see a pdoc; my GP suggested therapy, THEN called my insurance herself and got a list of covered providers and called me with it, since she was reasonably sure I would not do that on my own. She prescribed anti-depressants, but when it became clear that I needed more than that, she said it was "out of the scope" of her expertise and suggested a pdoc. THEN called my therapist (with my permission)to get her input as to which pdoc would be a good fit to refer me to. Now when I see her, we do not discuss anything psych related unless *I* think it relates, other tan she always asks if I am still seeing x and y, and is there anything new (meds etc) she needs to know about. Because of all of this, if she actually DID bring up psych related "stuff", I would be comfortable discussing t with her, and would trust that she would not base any conclusions solely on that!

Anonymous said...

Dinah,

I disagree that it isn't ok to lie to your psychiatrist. If you have a drug reaction that you fear will be wrongly perceived as a worsening of the illness, you have to whatever is necessary to protect yourself. Of course, if you have to lie in this situation, you probably have the wrong professional.

But sadly, many of your colleagues are clueless about drug interactions. Dr. Jay Cohen talks about this issue on this site:

http://medicationsense.com/articles/jan_mar_04/antidepress_side_effects.html

Scream - I thought I had heard everything as far as doctors prescribing antidepressants for every human condition known to mankind. But prescribing ADs when you need ankle surgery takes the prize. Did the doctors who wanted to give you that treatment get their medical degree from a crackerjacks box medical school? That greatly angers me and I think it occurs alot more often than we would like to believe.

AA

moviedoc said...

We have all lied at sometime in our life, but when I discover a patient has concealed the fact she has been obtaining treatment elsewhere, I may discharge her. It is not a moral issue; I just choose not to participate in what may be a sham.

Lockup Doc said...

I sincerely hope that as we move toward a universal electronic health record, patients can maintain some degree of control over who can access not only mental health treatment records but also any record of whether they are or have been in mental health treatment.

I am against the idea of anyone lying or withholding information from any health care professionals, but without some degree of privacy protection(give the control and the responsibility to the patients), I fear many in need of treatment will avoid it.

moviedoc said...

Scream: It's not just the disability police. Any mention of depression or substance abuse and my patients cannot get life insurance at almost any price. This means SHE must not submit an insurance claim or even use insurance for pharmacy benefits as well as not telling other docs, which may be dangerous if there is a potential drug interaction.

jessa said...

I have frequently lied in treatment. When I first began therapy, I was terrified and would answer questions with lies almost reflexively, then go home not knowing why I said what I did. I guess I just got scared and said the first thing that I could think of to get the question over with. I have been hurt in treatment a lot. I usually start out each treatment not intending to lie, but if I'm getting hurt in the process, if being honest means that the doctor or therapist is going to trample all over me and destroy me, I start lying to tell them what they want to hear to get out of there. (I have some recent blog posts about that.) Sometimes I need to lie to survive.

Rach said...

What would you say is the difference between lying and withholding information - where's the line drawn?

(Gotta think about all of this, a bit)

Anonymous said...

I wouldn't see a therapist or psychiatrist who used an electronic medical record. Too many people who don't have any business reading it can read it. The dermatologist doesn't need to know what I've said to a shrink. Frankly, I want to be the one who decides who gets to know what. That's my business.

My regular physician doesn't know I see a therapist, and she never will. She doesn't need to know unless I decide it's relevant.

Anonymous said...

I don't know how I feel about electronic medical records. After not having seen an internal medicine doctor for 6 years, I signed up for a new PCP closer to home. On the first visit, which was for a physical, the first thing the doc said to me was, "What about your mental health? What happened?" I had been discharged from a psych hospital 1 month earlier, and it was clear to me, even though I filled out a list of medications and health problems on a stock form, that he had logged into the EMR. These were not the asylum records--just records of the emergency room visit that led to commitment. The whole physical exam then became about my recent mental health crisis and the rest of my body got short shrift.

Still, I thought the new PCP was very kind and had a good bedside manner. During later visits, I find he spends very little time with me, secondguesses me, and likes to get me out the door. When I blamed a massive, rapid-onset weight gain on psych meds, he poo-poo'ed it and wanted to blame lifestyle.

I guess there is no way to hide patient information from a PCP, but the PCP is going to judge you, more than likely.

merope3 said...

I started lying to my doctors when it became obvious they were lying to me. It only seemed fair.

Anonymous said...

The lie is the bread and butter of the psychiatrist and the cornerstone of the therapeutic relationship. But you were the one who set up the appointment in the first place, weren't you? Your little lie is bought and paid for. Embrace your little lie. Poor little lie.

moviedoc said...

Shouldn't that be "embrace your inner liar"?

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moviedoc said...

If you use eprescribing (I'm switching to allscripts since iscribe is doing the same.) You may see a complete list of meds your patient has taken. This will help you catch those liars.

Big Brother is Watching!

Anonymous said...

Big brother is right.

Sarebear said...

EEek!

spotsy said...

When I'm at my first interview and they ask me about sexual abuse or domestic violence I always lie. I've been burned in the past by mental health and prmary care doctors making innapropriate comments and pushing me for details. I hardly know you, why would I tell you all of this stuff? Now alot of hospitals ask you at admission (JCAH thank you!) and I don't tell them either. If you say you don't want to answer they take it as a yes and push even harder. I pay privately for all my mental health care even though I have coverage so that I dont get a diagnosis label and I dont have to worry about insurance denials and lack of privacy.