Between 60 and 80 percent of people surveyed have not been forthcoming with their doctors about information that could be relevant to their health, according to a new study.
Besides fibbing about diet and exercise, more than a third of respondents didn’t speak up when they disagreed with their doctor’s recommendation. Another common scenario was failing to admit they didn’t understand their clinician’s instructions.
Fear of being ‘pigeonholed’?
“While the idea that patients may not share everything with their clinicians is perhaps to be expected, we were surprised at how common it appears to be for patients to withhold information or beliefs,” says study coauthor Brian Zikmund-Fisher, associate professor of health behavior and health education at the University of Michigan.
Most survey respondents said they wanted to avoid being judged or lectured by clinicians. Others were too embarrassed to tell the truth.
“Health care clinicians need complete and accurate information about patient behaviors and beliefs if they are to best serve and guide their patients. Perhaps by acknowledging how common it is for patients to withhold information, clinicians may be able to make it easier for patients to share their concerns and acknowledge their less-than-ideal behaviors. Such conversations will only occur, however, if clinicians address patients’ fears that they will be judged or lectured.”
Most people want their doctor to think highly of them, says study senior author Angela Fagerlin, professor of population health sciences at the University of Utah. “They’re worried about being pigeonholed as someone who doesn’t make good decisions,” she says.
When respondents explained why they weren’t transparent, most said that they wanted to avoid being judged, and didn’t want to be lectured about how bad certain behaviors were. More than half were simply too embarrassed to tell the truth, according to the study.
Insights into the doctor-patient relationship came from a national online survey of two populations. One survey captured responses from 2,011 participants who averaged 36 years old. The second was administered to 2,499 participants who were 61 on average.
The survey presented participants with seven common scenarios where a patient might feel inclined to conceal health behaviors from their clinician, and asked them to select all that had ever happened to them. Participants then recalled why they made that choice. The survey was developed with input from physicians, psychologists, researchers, and patients, and refined through pilot testing with the general public.
In both surveys, people who identified as female, were younger, and who self-reported as being in poor health were more likely to report having failed to disclose medically relevant information to their clinician.
“I’m surprised that such a substantial number of people chose to withhold relatively benign information, and that they would admit to it,” says the study’s first author Andrea Gurmankin Levy, associate professor in social sciences at Middlesex Community College in Connecticut. “We also have to consider the interesting limitation that survey participants might have withheld information about what they withheld, which would mean that our study has underestimated how prevalent this phenomenon is.”
Honesty is the best policy
The trouble with a patient’s dishonesty is that doctors can’t offer accurate medical advice when they don’t have all the facts.
“If patients are withholding information about what they’re eating, or whether they are taking their medication, it can have significant implications for their health—especially if they have a chronic illness,” Levy says.
Understanding the issue more in-depth could point toward ways to fix the problem. Levy and Fagerlin hope to repeat the study and talk with patients immediately after clinical appointments, while the experience is still fresh in their minds. Person-to-person interviews could help identify other factors that influence clinician-patient interactions. For instance, are patients more open with doctors they’ve known for years?
The possibility suggests that patients may not be the only ones to blame, Fagerlin says.
“How providers are communicating in certain situations may cause patients to be hesitant to open up,” she says. “This raises the question, is there a way to train clinicians to help their patients feel more comfortable? After all, a healthy conversation is a two-way street.”
Researchers from the University of Iowa and Wayne State University also contributed to the study. The findings appear in JAMA Network Open.
Source: University of Michigan