In 1997, Dr. Victor Freeman, then a primary care research fellow at Georgetown University Medical Center, asked 167 internists across the country what doctors should do if one of their patients was at first turned down for coverage of a treatment that was medically indicated.
Almost half -- 45% -- said it was ethical to lie in order to get coverage for the patient. The more serious the condition, the more doctors said lying was appropriate: 57% when bypass surgery was at stake for a patient with severe angina or chronic atherosclerosis; 47% when the issue was comfort care for a patient with terminal ovarian cancer causing abdominal pain and extreme nausea; 32% when a patient with severe depression was seeking a psychiatric referral.
For The Record
Los Angeles Times Saturday, June 13, 2009 Home Edition Main News Part A Page 4 National Desk 1 inches; 49 words Type of Material: Correction
Patient disclosures: A Health section article on Monday about how patients lie to their doctors and what can result said that Jerry Flanagan was an advocate with the Foundation for Taxpayer and Consumer Rights. The organization was formerly known by that name, but it is now called Consumer Watchdog.
For The Record
Los Angeles Times Monday, June 15, 2009 Home Edition Health Part E Page 4 Features Desk 1 inches; 48 words Type of Material: Correction
Lying: A June 8 Health article about how patients lie to doctors and what can result said Jerry Flanagan, quoted in the article, is an advocate with the Foundation for Taxpayer and Consumer Rights. The organization had been known by that name, but is now called Consumer Watchdog.
At other times, a doctor may be willing to help by leaving things out of a patient's record.
Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch in Galveston, Texas, suggests patients talk to their doctors if they have symptoms or conditions they fear could disqualify them for insurance coverage.
"There may be times when a doctor will agree to not put it on [record]," he says.
"But that's very iffy. It's not good medical practice as a rule."
Clarke suggests patients have two sets of medical records, a private one between patient and doctor and another for sharing with others.
"The solution is not to lie to your physician but to establish private records that won't be released to third parties," he says. "If your physician won't do that, it's reason enough to leave the physician."
Short of changing to a healthcare system where insurance companies can't refuse to sell anyone a policy because of a health condition -- which he favors -- Flanagan says there's no ideal solution for some patients.
Even so, most doctors, ethicists and patient advocates think it's a bad idea to lie to a doctor, although they all see reasons why patients might want to -- and even scenarios where a lie might be justified.
Some ethicists consider it a moral obligation for patients to tell the truth to their doctors, Brody says. In establishing a patient-doctor relationship, the first step is to take a thorough medical history.
"None of the rest makes any sense without an accurate history to guide you," he says.
Lying about what you eat, how much exercise you get or whether you're taking your medication as prescribed may seem benign but can be hazardous. If it seems you've been doing everything right, and your condition still isn't improving, the doctor could change your current treatment plan to something more serious and invasive -- and unnecessary.
As for embarrassment, perhaps patients worry too much about what their doctors think of them.
"Doctors have heard it all," Klitzman says. "They've seen it all."
In other words: Get over yourself.
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health@latimes.com
