Forming relationships with patients that are based on mutual trust and honesty is an integral part of quality patient care. As a medical practitioner, you already know you need to fully comprehend the facts of your patient’s situation; in turn, your patient needs to believe that you have their best interests in mind. But do they trust you enough to tell you the truth?
When the patient-practitioner relationship breaks down due to lack of trust or honesty, the entire basis of medical care is compromised. The trust relationship is akin to a scaffolding on which all future medical decisions are based. Patients who are less than forthcoming with their medical providers imperil the structural integrity of that scaffolding. Likewise, healthcare providers who undermine patient relationships jeopardize the scaffolding’s ability to support both patient and healthcare provider.
Power Dynamic at Play
In your relationships with patients, you are inherently the dominant party in the sense that you have the background, reputation, education, and knowledge patients need to resolve issues they can’t resolve themselves. Both parties understand this dynamic going in: the healthcare provider is the knowledgeable expert who maintains a professional role, and the patient is the more vulnerable party who shares very personal information and relies on the healthcare provider’s skills to help them.
There’s nothing wrong with this power dynamic. After all, the suppositions are true: you do hold the knowledge and expertise to potentially solve the patient’s problem. The patient’s part of the bargain is that they reveal personal details that they might never share outside your office.
As equal as the power dynamic is between you and your patient everywhere else, here you hold the upper hand, so to speak. This reality makes your efforts to create trust with patients even more significant. Breaching trust through words or actions may cause patients to be less than fully honest after they enter the exam room.
Why Patient-Provider Honesty Matters
A wide range of problems can arise when medical personnel create an atmosphere where patients feel they can’t trust their healthcare providers. This potentially dangerous situation could cause more serious damage than simply some miscommunications. The complications can be far-reaching and serious. You might draw inaccurate conclusions about your patient’s health, for example, or base your medical decisions on those inaccuracies. Other consequences include:
- Incorrect healthcare advice
- Overdosing/underdosing of necessary medications
- Incorrect prescriptions
- Patient’s short-and long-term health in jeopardy
- Damage to physician’s professional reputation
- Increased possibility of malpractice
Why Patients Lie
A large body of research documents the various reasons why patients lie to their healthcare providers. Overwhelmingly, the core impetus has to do with judgment and distrust. Although the surface reasons vary from patient to patient, the underlying motivation is the avoidance of judgment. Patients adjust their answers and alter their narratives to avoid receiving negative judgments from their healthcare providers.
In fact, the 2022 “Top Reasons Patients Lie About Their Health” survey from Berxi, in which patients could chose more than one option, revealed that the top five reasons relate to shame and fear of judgment:
- Fear of judgment: 33%
- Embarrassment: 31%
- Shame: 24%
- Judgment from a previous medical professional: 21%
- Denial/avoiding the truth: 19%
The Berxi survey also asked patients to provide details on a recent experience of lying to a medical practitioner. The answers offer valuable insight:
- “I lied because I don’t want to be scolded for not following medical advice,” said a 50-year-old male.
- “I didn’t want them to think my health issues were due to feeling depressed because they’d discount my symptoms,” responded a 29-year-old female.
- “I was afraid of what their reaction would be; whether they would think differently of me because of my drug use, or discriminate against me based on my gender identity or sexual orientation,” replied a 21-year-old male.
Hundreds of other responders gave similar answers. Patients from a broad spectrum of ages and genders expressed their fear of being judged and a desire to steer providers away from certain facts by not revealing their full medical histories.
Teresa Lovins, MD, a primary care physician based in Columbus, IN, weighed in on the phenomenon of patients lying to their healthcare providers. “I wasn’t completely surprised. Especially when there’s a new patient, I always have on my radar the possibility that the patient isn’t being fully upfront with me. After all, I don’t have much experience with that person and have not yet created a nice relationship with them. The patient likely wants to put his or her ‘best foot forward’ and may not tell me the whole story.”
In another study reported in the National Library of Medicine journal, 60% to 70% of 4,510 Americans admitted that “they had not been forthcoming with healthcare providers about information that could be relevant to their health…. More than one in five didn’t disclose their unhealthy diets or lack of exercise.”
How can this situation be improved?
How to Encourage Patients to Trust You
Even if the patient-practitioner relationship dynamics are somewhat unique, you’re still forming a type of human relationship in which trust plays a vital role. Here are some ways to build trust with your patients, according to Betty Chaar, a senior lecturer in pharmacy practice and professional ethics at the University of Sydney.
1. Demonstrate Respect With Shared Decision-Making
“Every patient deserves to be treated with dignity and respect,” writes Chaar. Shared decision-making is one way to demonstrate patient respect and encourage patient autonomy.
One way to demonstrate respect and encourage shared decision-making is to ask open-ended rather than closed-ended questions. For example, you could ask, “What physical reactions to your new medication are you feeling?” rather than asking, “Are you having rashes?” These types of questions might also convey to the patient that you’re interested in hearing the whole story instead of just picking and choosing what might get you out of the office as soon as possible.
2. Use Body Language
Body language plays a large role in a trusting relationship. Nonverbal cues can negatively impact the trust relationship. One compelling study conducted by the University of Pittsburgh Schools of the Health Sciences showed that racial bias may be conveyed by body language.
The reverse is equally true: body language can convey trust. As Dr. Lea Lis, MD, a clinical professor at New York University, says, “Often, it's the nonverbal messages we send in our gestures, facial expressions, or posture that can cement or invalidate our words. These nonverbal cues can strengthen the verbal messages you're sending or [they] can lead to mistrust or confusion — signs of poor communication and misunderstanding.”
Positive body language behavior that can show approachability includes:
- Making eye contact with patients
- Not multitasking (i.e., typing notes, browsing for information online) while the patient is speaking
- Occasionally looking up from notes to nod agreement or affirmation of the patient’s concerns
3. Be Direct and Compassionate
Chaar recommends being direct and honest in your verbal communication. She explains that if patients feel their healthcare providers are being superficial in any way, patients are likely to lose respect and providers to lose credibility.
This means being both candid and compassionate about the patient’s care plan; avoid speaking in cliches, but try to connect with your patient on what could really work for them. Say a patient is talking about exercise or eating well (two categories patients are likely to lie about). You could say, after looking at their data, “My concern is that your weight has increased about 10 pounds each year for the past four years. And a lot of that is just due to life changes and getting older, so we are going to need a strategy to make some realistic changes. This does not mean losing 40 pounds in one year, but it means preventing the gain of another 10.”
Then ask some thoughtful questions about habits and routines to leave the patient with a few strategies they feel they can actually do. Leave them feeling in charge, and not ashamed.
Another important way to authentically connect is to avoid using acronyms that patients are unlikely to be familiar with or medical jargon that will confuse them. Speak their language and get on their level as their advocate and guide.
More Ways to Create a Judgment-Free Atmosphere
Contributing to a judgment-free atmosphere can consist of changes to both the physical environment and the attitudes, words, and body language of medical staff. Here are some extra ways for your entire team to help patients feel more connected with you, gleaned from guidelines from the American Medical Association.
- Post a sign reading, “You are in a judgment-free zone.”
- Make eye contact with patients and avoid talking to them while looking down at forms, typing, or reading their screens.
- Have a genuine introductory exchange of words with each patient. “Hi, how’s the weather out there today?” or “You’re in good hands with Dr. So and So,” or “Are you feeling better since your last visit?”
- Avoid verbalizing reactions or making facial expressions when people are being vulnerable. This means when they’re talking and sharing, and also when they weigh in or have blood pressure taken.
- Stock exam rooms with a range of gown sizes that will fit everyone; slim or obese. Don’t create the need to “go find a bigger gown.”
- Ask if the patient is comfortable before disappearing from the exam room while they await the doctor.
- Share objective personal anecdotes when appropriate. “A relative of mine has to take this medication and she hates the taste. Sometimes she takes orange juice with it instead of water. You might like to try that, too.”
- Find out what the patient is thinking without discounting their experience. Ask, “I’ve read a lot about the mysterious symptoms you’re describing. What have you read?”
- Be in it together. Invite the patient’s input as to care. “Let’s figure this out together. You tell me exactly what’s going on, and I’ll share what I know about this condition.”
When patients trust their medical providers, everybody wins. Earning patients’ trust and encouraging honest communication are as much a part of your job description as prescribing the best medicine or ordering the right tests. Use the statistics in this article as motivation to do your part in making patients feel safe in your care and in your office. The insights and strategies shared here should put your practice well on the way to providing a safe and trusting office environment where patients feel good about speaking their truth.