Lessons From a Previous Life
Lessons From a Previous Life
Earlier this year, a study conducted by General Electric with the Cleveland Clinic and Ochsner Health System found its way into the mainstream press, in which 28% of surveyed patients reported that they have lied to their doctors at some point.
Many laypeople and physicians were shocked by this figure. Doctors are supposed to be the one group of people to whom you don’t lie. After all, HIPAA and the doctor-patient confidentiality covenant prohibit us from repeating anything that we are told. Furthermore, it seems as counterproductive for someone seeking help with a medical complaint to tell a lie, and thereby risk the possibility of receiving insufficient or inappropriate treatment. (Though to be fair, one can understand a patient’s reluctance to tell the truth for fear of embarrassment or in an attempt to please his doctor.)
I read this a different way. Having spent years negotiating over the prices of stocks, bonds, companies, and virtually anything upon which a price tag can be attached, I’ve learned that every statement must be taken with a degree of skepticism. I would never start a business negotiation with the truth of what I could or would pay. In business school classes on negotiation we’re taught to make an opening offer that is “unacceptable but not unreasonable.” In other words, we are told to open with a lie. Since I know the person across the negotiating table likely took the same classes and is also opening with a lie, there is nothing immoral or objectionable about the practice — it is simply the way things are done, and both sides of the table are fully aware of the landscape in which we are operating.
After reading the GE-Cleveland Clinic-Ochsner study, I reasoned that it was safe to assume there was a large segment of the remaining 72% who lied to the survey-taker about lying to their doctors, making them not just double-liars but also raising the true figure of those telling mistruths to greater than one-third of all of our patients.
Just as a lie didn’t shock me when I was working in finance, neither should it when I’m working in the ED. Of course I’m not advocating that we ignore what our patients tell us. Rather, I’m advising that we avoid falling into traps by limiting our examinations and differential diagnoses based solely on the word of our patients — after all, a third of them may be lying to us.
1) Everybody Lies
Earlier this year, a study conducted by General Electric with the Cleveland Clinic and Ochsner Health System found its way into the mainstream press, in which 28% of surveyed patients reported that they have lied to their doctors at some point.
Many laypeople and physicians were shocked by this figure. Doctors are supposed to be the one group of people to whom you don’t lie. After all, HIPAA and the doctor-patient confidentiality covenant prohibit us from repeating anything that we are told. Furthermore, it seems as counterproductive for someone seeking help with a medical complaint to tell a lie, and thereby risk the possibility of receiving insufficient or inappropriate treatment. (Though to be fair, one can understand a patient’s reluctance to tell the truth for fear of embarrassment or in an attempt to please his doctor.)
I read this a different way. Having spent years negotiating over the prices of stocks, bonds, companies, and virtually anything upon which a price tag can be attached, I’ve learned that every statement must be taken with a degree of skepticism. I would never start a business negotiation with the truth of what I could or would pay. In business school classes on negotiation we’re taught to make an opening offer that is “unacceptable but not unreasonable.” In other words, we are told to open with a lie. Since I know the person across the negotiating table likely took the same classes and is also opening with a lie, there is nothing immoral or objectionable about the practice — it is simply the way things are done, and both sides of the table are fully aware of the landscape in which we are operating.
After reading the GE-Cleveland Clinic-Ochsner study, I reasoned that it was safe to assume there was a large segment of the remaining 72% who lied to the survey-taker about lying to their doctors, making them not just double-liars but also raising the true figure of those telling mistruths to greater than one-third of all of our patients.
Just as a lie didn’t shock me when I was working in finance, neither should it when I’m working in the ED. Of course I’m not advocating that we ignore what our patients tell us. Rather, I’m advising that we avoid falling into traps by limiting our examinations and differential diagnoses based solely on the word of our patients — after all, a third of them may be lying to us.
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