During 2016, over 84 percent of adults had contact with a healthcare professional. An earlier article reported that in a defined patient population (Olmsted County, Minnesota) of 142,377 patients, the most common reasons for doctor visits included skin disorders (42.7 percent), osteoarthritis and joint disorders (33.6 percent), back problems (23.9 percent), disorders of lipid metabolism (22.4 percent), and upper respiratory tract disease (22.1 percent, excluding asthma).
In the delicate doctor-patient relationship, not telling the truth to patients requires special attention because patients can suffer serious harm if lied to by their physicians. Not only is patient autonomy undermined, but patients who are not told the truth may experience a loss of trust, and trust is essential for healing.
Honesty matters to patients because they are ill, vulnerable, and burdened with pressing questions that require truthful answers. Unfortunately, both patient and physician are challenged by difficult or complicated communications that often results in withholding, distorting, fabricating, or outright lying about information that is crucial to this relationship.
Similarly, patient failure to disclose medically relevant information to their physicians can undermine patient care or even lead to patient harm.
A recent survey showed that patients commonly withhold medically relevant information from their clinicians, a pattern that may adversely affect the quality of patient care.
Scientists at the University of Utah Health and Middlesex Community College, in collaboration with colleagues at University of Michigan and University of Iowa, gained some insight into the doctor-patient relationship from a national online survey of two populations. One survey captured responses from 2,011 participants who averaged 36 years of age. The second was administered to 2,499 participants, who averaged 61 years of age.
Survey participants were presented with seven common scenarios (i.e., did not understand instructions, medication use) and reasons for nondisclosure (i.e., embarrassment, not wanting to be judged) in which patients might feel inclined to conceal health behaviors from their clinicians and were asked to select all the scenarios that they had ever experience had ever happened to them.
Participants were then asked to recall why they a specific choice. The survey was developed with input from physicians, psychologists, researchers and patients and refined through pilot testing with the general public.
The results from both survey samples showed that 60 to 80 percent of participants had not been forthcoming with their physicians about information that could be relevant to their health. Most participants reported withholding at least 1 of 7 types of medically relevant information, especially when they disagreed with the physician’s recommendations or misunderstood instructions.
The most commonly reported reasons for nondisclosure included not wanting to be judged or lectured (81.8 percent), not wanting to hear about their potentially harmful behavior (75.7 percent) and feeling embarrassed (60.9 percent). In both samples, participants who were women, younger, and sicker were more likely to report withholding information, indicating that the very patients who are in the greatest need of high-quality healthcare may be more likely to compromise their care by withholding important information from their physicians.
Unlike the previous studies that have focused on a single issue, such as alcohol use or use of complementary and alternative medicine, this may be the first study to more broadly examine patients’ nondisclosure of medically relevant information when communicating with their physicians.
Interestingly, the study highlights that nondisclosure can occur for even relatively mundane reasons, such as not understanding the instructions. According to the study authors, if patients are withholding information from physicians as frequently as this research suggests, then physicians are routinely not receiving the information that they need to provide high quality care to patients, especially very sick patients.
To maximize therapeutic benefits and avoid potential harms, patients need to feel comfortable enough to be honest and open. Future research should test interventions that aim to increase the trust and communication between patients and their physicians as well as patients’ comfort with disclosing information to their physicians.
