5 Types of Lies Your Patients Might Be Telling You

Nursing school does not warn you about this one: patients lie. Not all of them, and rarely out of malice, but often enough that you learn to read between the lines. Here are five lies you will hear again and again, and how to work around each.

1. "I take my medicines exactly as prescribed."

Most patients will not admit they skipped doses or stopped a drug early. They worry that confessing noncompliance means more medication and a longer treatment. That worry is exactly where the danger starts.

If a patient says they are taking everything on schedule, we assume the prescription is failing and the provider may raise the dose or add drugs, putting the patient at risk for overdose, side effects, and dangerous interactions. Compliance is essential to recovery. When you doubt it, ask the patient to show you how they take their meds. You will quickly find out if they are struggling to swallow them or quietly stopping because of side effects.

2. "Ouch, I'm in so much pain!"

Pain assessment is its own art. We have all met the patient laughing while rating their pain an 8, and the patient demanding pain medication with no sign of discomfort.

One ER nurse shared this: "A patient came in complaining of pain all over his body. The doctor could not pin down a source, so he ordered a series of tests. The patient got uneasy when he learned his card would not cover them. A few minutes later he reported feeling better." Assess what the patient says and what the patient does. When the two do not match, reassess, reorient them to why honest pain reporting matters, and ask them to describe the pain and where it sits.

3. "I don't drink much."

Most patients who drink will not fully disclose how much. Some are in denial. Others fear judgment from their doctor. One nurse put it this way: "I asked a patient in the clinic how many bottles of beer he drinks a day. He said one. I asked twice to be sure. When the doctor asked the same question, he nervously said six." Avoid probing questions when you assess drinking, since they push patients to defend themselves. Build trust and keep your responses nonjudgmental.

4. "I did not have sex."

This is one of the most common lies from teens who arrive in the ER with abdominal pain and a missed period. Many deny being sexually active, and deny having a partner at all, especially with a parent at the bedside. Stay objective and weigh the test results over the patient's account. Confront the lie gently to keep their trust, and find out whether they have taken anything to end a possible pregnancy.

5. "I don't take any other medicines."

Patients often assume we only care about drugs prescribed by other doctors. Others simply forget the sleep aids, diet pills, vitamins, and herbal supplements they take now and then. Even unprescribed, those can cause drug interactions. Do not assume the patient is hiding something, since plenty are just forgetful. Walk them through their daily routine and you will surface the medicines they would never think to mention.

Patient lying is not rare. It happens every day. It also does not mean patients cannot tell the truth, especially once they understand what is at stake. Earning that trust is part of the job.