I believe in transparency and open communication. I tell my patients the truth and expect the same in return. The truth seems to have a way of coming out eventually anyway. Establishing a complete and accurate history early on in our relationship will lead to less unnecessary testing, less office visits, and far less uncertainty. Just remember that I am simply trying to understand what is going on with you in order to help you get better.
It seems like such a simple concept but I am always a little surprised at the amount of half-truths, omissions, and outright lies I get told on a daily basis. Here are a few recent examples:
As a part of a routine history I always ask about smoking, drinking, or drug use. It’s not because I want to judge you, but often I need to know if you have certain risk factors for diseases such as cancer (smoking), liver disease (excess drinking), and many other issues related to drug use. Just two days ago, I asked these routine questions to a patient in the hospital and she answered “no, nothing at all, nope, not me doc” to everything. Unknown to me at the time, her primary doctor sent a urine toxicology for some reason or another. The test came back yesterday…positive for marijuana, positive for cocaine, and positive for opiates.
Every once and a while in the office, a new patient (almost always a man) comes in with vague complaints of “not feeling well,” or “problems with digestion.” It turns out later, after initially denying it, that the patient has been having rectal bleeding for months. Sometimes the only way I find out is when the patient’s wife comes in with him and elbows him in the side for lying to me, and says “there is blood in the toilet almost every day honey, tell the doctor the truth!”
Outright lies are less common than half-truths. More often than not telling me everything, I get a story that omits or downplays several key facts. The ulcerative colitis patient that is actually having six episodes of diarrhea a day tells me he is only moving his bowels twice a day. The patient with alcoholic cirrhosis who tells me she only has a drink on Christmas and her birthday who is actually drinking a few glasses of wine every night according to her daughter.
The thing is, I really have heard almost everything by now. I trained at Bellevue Hospital. I literally think that I have seen it all. Middle-aged business man who lost control of a large carrot one weird night…check. Two carrot insertions by different patients in the same week…check. Domestic dispute that ends with me sewing up a knife wound to the boyfriend, while the police wait nearby ready to return him to his girlfriend (who he misses) that stabbed him only a few hours ago…check. Countless prisoners who swallow sharp items just to get out of jail and into the hospital for a few days…check. I could go on forever with the stories, the bottom line is that you’re not going to surprise me with what comes out of your mouth. And please don’t be embarrassed by what you really need to say…if you only knew what I hear on a daily basis you would realize that talking about the fine details of your bowel habits for ten minutes is just another day in the office. I can only help you with certain issues if you tell me about them. Not everything shows up on lab tests and my crystal ball is still in the shop…
Please tell your doctor the truth.
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