A significant majority of U.S. adults have admitted to withholding medical information from their healthcare providers, according to a major study. Between 60 and 80 percent of individuals surveyed reported holding back at least one pertinent health detail during a medical visit.
The primary reasons cited for this lack of transparency include not wanting to be lectured, fearing judgment for their behavior, and feelings of embarrassment. Women, younger individuals, and those who self-report having the worst health were found to be most likely to conceal information.
Furthermore, a history of societal discrimination can foster distrust in the medical system, leading some patients to withhold information. Research indicates that individuals who have experienced discrimination are more prone to withholding details from healthcare providers. This distrust can be exacerbated by past negative experiences, particularly for women and people of color.
The rise of self-directed healthcare practices has also created barriers, with over 40 percent of U.S. adults who use alternative or complementary medicine not disclosing this to their primary care physician.
The Patient's Dilemma
Dr. Ronald Epstein, a professor of family medicine at the University of Rochester Medical Center, acknowledged that even healthcare professionals can be tempted to withhold information. He shared an instance where he omitted a fall he experienced while skiing from his doctor to avoid extensive follow-up tests, given his age and routine fall screenings. However, Epstein cautioned against this practice, noting that a fall could potentially signal underlying neurological or balance issues.
"The danger in doing that, of course, is if someone actually fell while turning around on a landing while going downstairs, that could signal some kind of balance or neurologic disorder," Epstein stated.
Clinicians cannot provide optimal care without a complete health picture, a fact especially critical in high-stakes situations. One study revealed that one in four patients experiencing imminent threats to their well-being, such as depression, suicidal ideation, abuse, or sexual assault, withheld this information due to fear of embarrassment or judgment.
There are specific categories of information that healthcare providers critically need for proper evaluation: current prescription medications, adherence to prescribed dosages, and the consumption of other substances, including legal but potentially harmful ones like tobacco and alcohol, as well as illegal drugs, and the extent of their use.
Epstein proposed a key question for patients to consider: "Would withholding this information threaten or enhance the health of the person involved?" This question prompts individuals to assess whether withholding information could jeopardize their health or the health of a loved one, or if sharing it could lead to a better outcome.
Ultimately, the decision to disclose rests with the individual, but Epstein advises against assuming one knows better than their doctor. "you’re taking the risk that you know better versus being transparent and letting your doctor make that judgment."
A Shared Responsibility
Epstein described the doctor-patient relationship as a "shared responsibility," encompassing both the technical aspects of medicine and the relational elements of trust and understanding.
He recalled his training in the 1980s during the AIDS crisis, noting the challenges doctors faced in discussing sensitive topics like sex, which, along with drugs and money, can significantly impact health.
Communication methods employed by doctors can inadvertently create barriers. A blunt question about medication adherence may lead to a dishonest response, whereas a more empathetic approach can elicit greater honesty. "If the pills are something that if you miss a dose, you might suffer severe consequences, then it can be life and death," Epstein said.
To ensure patients comprehend medical advice, doctors can encourage them to repeat instructions. Open-ended questions, such as "what questions do you have?" instead of "do you have any more questions?", can foster more comprehensive dialogue and address patient anxieties.