Thursday, September 30, 2004

Yet more on lying

If I had known that Medpundit would link to my post about patients lying to the doctor, I would have added more commentary. (Blogging is a lot easier when you're sure that no one is reading your blog!) What I should have added:

a. Malingering and factitious disorder were discussed in a previous post. (To keep it simple, I didn't use the word "factitious.")

b. WebMD polled its readers with no attempt to explore unconscious motivations. It's the psychiatrist's job to try to figure that out.

c. Doctors are extremely wary of being scammed for drugs (especially narcotics and tranquilizers.) I don't think I appreciated the extent to which patients distort their history to avoid feeling hassled by the doctor, or embarassed (or fired) by the doctor.

d. It's still the doctor's responsibility to listen for discrepancies and help patients feel comfortable sharing sensitive information. WebMD has some suggestions for asking questions in a non-judgmental way. Sometimes I have to say, "of course you don't have to tell me everything, but patients get much better care when we know certain things about them." Sometimes, they need reassurance that we won't abandon them or condemn them. Psychiatrists often have an uphill battle, collecting some types of info. Patients know that they can be locked up against their will for certain things.

e. The library just sent me some articles about physicians' truth-telling to patients. (Did you just have an awful vision of an office visit, with the patient and doctor both misleading each other? Me, too.) To be continued....


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