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What's Your Truth Serum?

Patients are notoriously unreliable sources when it comes to reporting on their health behavior and histories.

For example, people tend to underestimate their caloric intake, while overestimating their level of physical activity and adherence to therapeutic regimens. Sometimes the inaccuracy is intentional. More often it is likely due to poor recall or miscalculation.

How can the astute health professional sort fiction from fact?

DOC News asked:

How do you elicit the truth from patients when taking histories or reviewing treatment compliance?

People don't often deliberately lie to the clinician, but they often lie to themselves. They overstate their physical activity and understate their caloric intake. Giving them some tools to actually quantify [their answers] is helpful—a pedometer, a journal of physical activity, food diaries. Also, building a relationship allows them to be honest and tell you how it is, and it isn't always good news.

Alan Glicklich, MD Internist Princeton, N.J.

There are many signs, nonverbal language, that the person is not being completely honest. We ask for details, like whether they feel muscle soreness after exercising, or what their heart rate is while walking or running—to check for consistency in what they're reporting.

Jorge Lopez Arriola, MD Internist Naucalpan, Mexico

Rather than ask patients about last week or month, ask, "How many times did you XYZ in the last three days?" Or, "What did you eat yesterday?" That gives you a more recent read on what they're doing. Then you can ask other questions, go in another direction.

Carla Berg, PhD Clinical Psychologist Minneapolis

Once you build trust in a relationship, patients will tell you anything, even if it's bad. I've been told totally unexpected things about their diet, how hard it is to diet, how hard it is to exercise. I can relate; I've gained 10 pounds since [Hurricane] Katrina, and I'm not getting enough exercise.

Julie Morial, MD, MPH Medical Director Baton Rouge, La.

I like to get out of the idea that patients are lying. That's a stereotype. What they are doing is misremembering. The idea is to get people to document what's happening in real time. That takes the pejoratives out of it. People remember by cues, and we tend to ask blanket questions rather then helping pinpoint the information. [I try to] jog their memory with follow-up questions. I ask, "How much exercise did you do yesterday?" rather than "Do you exercise?" You break it up into manageable time periods for them.

Martin Binks, PhD Program Director Durham, N.C.

Footnotes

Editor's note: Thank you to all of our DOC News contributors.

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