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Patients may lie to protect their medical records from insurers
 Michael D. DePaolis |
In a recent Los Angeles Times article, “Body of lies: Patients aren’t 100% honest with doctors,” (June 8, 2009) Karen Ravn details an alarming trend in which patients lie to their doctors. While any seasoned clinician is not necessarily shocked by this revelation, what is surprising is the frequency with which patients lie – and their reasons.
Ms. Ravn reports on one analysis of more than 500 studies in which researchers conclude that – on average – about 25% of all patients lie to their doctor. They are quick to say this practice is probably even more common, as some of these study patients probably fudged their answers a bit.
The concern, of course, is that patient lies result in delayed or incorrect diagnosis, ineffective treatments and increased health care costs over the long run. So, why lie in the first place?
Fundamentally, patients lie for a variety of reasons. It might be an adolescent reporting exceptional contact lens compliance, only to have his or her parent detail a history of unsanctioned overnight wear and breaches in lens care. It could be a glaucoma patient reporting strict compliance, while eye drop consumption suggests otherwise. Or it could be the diabetic who professes meticulous blood glucose control whose retinal findings suggest otherwise. While it is difficult to imagine a case in which lying is justifiable, there may be a method to this madness.
Some patients lie simply because it seems harmless. Witness the patient who sleeps in daily wear contact lenses with no immediate adverse sequelae. Others lie for financial reasons, such as a glaucoma patient who skips his or her nightly drops to “stretch” the bottle – a practice which, although embarrassing, saves money. Then there are those who are afraid of visiting doctors. They simply suppress symptoms in hopes of avoiding a serious diagnosis. While potentially dangerous, each – at some level – is understandable. After all, we are human.
Of all the reasons patients withhold the truth, one is particularly disturbing to me. It is the scenario in which a patient lies to protect his or her medical record. More and more patients feel the need to withhold information from their doctors so it does not end up in the hands of insurers. In an era in which insurers deny coverage because of a pre-existing condition or even retroactively cancel a policy when medical records conflict with an insurance application, patients are increasingly guarded in what they share with their doctors. Any time doctor-patient communications are constrained, it is not a good thing.
While I respect the insurance industry’s role in our health care system, the doctor-patient relationship must take precedence. Reviewing a medical record for quality assurance or claim processing is one thing. Accessing a medical record to deny or revoke coverage is quite another. It is not good for patients, it is an impediment to providing care and, in the long run, it does not bode well for our health care system, either.