The Truth About Healthcare Consumers

Arguably the most important lesson I’ve learned in dealing with the healthcare system is that doctors will listen to and hear only the first thing you tell them during an exam. If you say you’ve got a headache and have been tired while both your arms are covered with an oozing poison ivy rash from pulling weeds out of your side yard, they’ll ask you when did the headaches start?

It’s how we train doctors. They ask the patient what brought them in today, and we’ve taught them that the first thing a patient says is the main reason they came in. Doctors tune out anything after that. They want to get to the heart of the matter as quickly as possible.

Now, when I need to see my primary care physician, in-network medical specialist, urgent care physician assistant or a triage nurse in the emergency room, I get right to the point. I tell them one thing and one thing only. I don’t bury the lede, as they say in journalism.

That gives me the power to control the medical encounter as a healthcare consumer. They will respond to what I tell them in terms of symptoms and what happens next. Yes, Mr. Burda, I do see that you have a severe oozing poison ivy.

That’s all fine and good if you’re an honest, well-intentioned and educated healthcare consumer. What if you’re not? What if you use that dynamic to steer the conversation in a different direction or not have the right conversation at all?

Two new studies suggest that it’s more common than you think.

The first study appeared last month in JAMA Network Open. It’s based on a survey of 959 patients who went to see their doctor because they were experiencing symptoms of a cold, flu or sore throat. It asked the patients whether they ever “misrepresented” their symptoms, i.e., lied, to a clinician in order to get prescribed antibiotics.

Amazingly, 268 patients, or 27.9%, said they did lie! Some said they exaggerated their systems like saying they had a cough for two weeks when they only had it for one. Some fabricated their systems like saying they had a fever but really didn’t. And some did both—exaggerating and fabricating.

“Our findings align with prior research on the phenomenon of patients withholding or misreporting health-related information, contributing to a growing body of literature demonstrating that a substantial proportion of patients misrepresent or withhold medically relevant information,” the study said.

The second study appeared earlier this month in the journal Psychiatric Service. It’s based on a survey of 100 adult patients discharged for inpatient psychiatric care. The survey asked patients about their use of AI chatbots and whether they shared that information with their doctors.

Sixty-one percent of the patients said they used AI chatbots with 30% of them saying they used them specifically for mental health purposes. Of those who used them specifically for mental health purposes, 37% said they deliberately chose not to tell their doctors about it with only 13% saying they openly discussed their AI chatbot interactions with their providers.

“AI chatbot use among individuals hospitalized for psychiatric care was found to be common, clinically relevant, and largely undisclosed, highlighting the need for clinicians to ask their patients about chatbot use,” the study concluded.

The question is healthcare consumers are selective in what they tell or don’t tell their clinicians, as these studies show? As a long-practicing amateur psychologist, my diagnosis is patients think providers are too judgy. They don’t want providers to downplay their symptoms, and they don’t want providers to criticize their Internet use.

Either way, providers respond to what patients tell them. That’s good. Now the trick is getting patients to trust providers enough to tell the truth.