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Truthfulness, physicians are repeatedly taught, is essential to the contemporary patient-physician relationship. Much has been written regarding truthfulness in medicine, especially concerning modern-day assumptions about physicians' obligations to tell the truth to their patients. Indeed, many physician professional groups and societies have instituted and published policies on truth telling,1'2 raising the collective level of consciousness about what the profession expects from its practitioners. The ethical notion grounding these physician obligations is that patients, or their surrogates, need accurate information, conveyed in language understandable to the patient or surrogate, on which to base an informed judgment to accept or refuse a physician-recommended intervention. Even in cases where there is still debate about the need for total physician disclosure,3 truthfulness is the default position for physicians' communications with their patients.
But what about patients' obligations to tell the truth? It is assumed that for hospital patients with acute medical needs, patient truthfulness is essential to safe and positive outcomes as well. Treatment plans based on incorrect or incomplete patient information can lead to a medical catastrophe, such as unnecessary emergency interventions or a missed diagnosis with a potentially fatal outcome. In the workup of suspected pulmonary embolism, for example-which is a frequently missed, frequently fatal diagnosis-the probability of the diagnosis is judged according to the use of the Wells criteria, a well-validated assessment tool that, although comprised mostly of objective criteria, can be undermined by a patient's false self-reported history.4
But the harm of patients' lies goes beyond the potential risks to patients; it includes potential harms to physicians and society. What if a physician learns during the history and physical that leads into the average consent process that the patient is lying or has lied about his or her present symptoms, reasons for being at the hospital, or past symptoms on which present diagnoses are based? Such a discovery distorts the informed consent process and substantially complicates physician obligations. What if the physician learns about a patient's lie that has not just put the patient at risk of harm, but has wasted staff time and hospital resources?
What if the patient's lie has resulted in potentially criminal fraud and abuse?
This article presents just 3 possible scenarios, stories in which patients told lies of convenience that...