Readers of this blog know that the most common form of medical malpractice is misdiagnosis. There are a number of reasons doctors misdiagnose patients. Among them are impatience on the part of the doctor, a rare illness or a common illness with an unusual presentation, the presence of confirmation bias, and some others. One of the others is a poor history from the patient.

A good patient history is an essential part of the diagnostic process: What are your symptoms? When did they begin? Are they constant or do they come and go? Tell me about family illnesses. With what conditions have you been diagnosed in the past? What medications do you take? Are you keeping up with your medications?

All of these are questions that can obviously help your doctor zero in on what ails you. Most patients will have very little problem answering these questions accurately and truthfully. There are some other questions, however, that cause many of us to pause and think whether we want to be completely honest with the doctor. Often the answer is no.

For example,

  • How much alcohol do you drink in a week?
  • How many sexual partners have you had in the last year?
  • When you have sex, is it protected?
  • Do you take recreational drugs?
  • Are you now or have you been depressed recently?
  • Are you in an abusive relationship?

Medical records are essentially forever. They are now kept electronically so they can travel with you from doctor to doctor and from hospital to hospital. Once a “fact” enters your medical record, it often gets repeated over and over. Under the best of circumstances, this can discourage a patient from being completely candid with the doctor taking a history.

Doctors know this is happening. It is accepted wisdom among doctors to double the amount of alcohol patients admit to drinking and cut in half the amount of exercise they claim to get in order to obtain an accurate answer to these questions.

Two recent studies reported in the online journal JAMA found that 81% of the survey respondents admitted to withholding at least some information from their doctor. As the authors noted, withholding information is like asking the doctor to make important decisions with one hand tied behind her back. Not only may the missing information result in a mistaken diagnosis, it may cause actual harm to the patient. For example, incorrect information about medications may result in harm, if the doctor prescribes a medication which will react poorly with one the patient is already taking, but which is not disclosed.

Among the reasons people withhold information from their doctor are embarrassment, concern over the privacy of the medical records, anticipation of physician disapproval, fear of being shamed, belief that the information is irrelevant, belief that the doctor can do nothing to help anyway, and fear that the doctor may prescribe medications the patient does not want to take. There are undoubtedly more.

While many patients are guilty, according to the studies, some are more likely to answer untruthfully than others. Patients who were white, female, younger, and who self-rated their health as below average were significantly more likely to have withheld at least some information from their doctor. Also, sicker patients were more likely to withhold information. Ironically, those who need help the most are most often the people who sabotage their care.

A successful physician/patient relationship depends on honest, open communication and the existence of trust. Knowing that patients often withhold information, especially in certain areas and about certain subjects, it is important for doctors to make patients feel comfortable, to create an atmosphere of trust, and make sure the patient knows the doctor will not be judgmental. Patients must also be confident that their records are private and will remain that way.

All of this is, of course, easier said than done. If this was a problem with an easy solution, so many patients would not be withholding information from their doctors. Human nature is a powerful thing and hard to overcome but know that not telling your doctor the truth has consequences and can be harmful to your health.

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