COMMENTARY

Silence Isn't Always Golden: Why Patients Keep Crucial Info From Clinicians

Brianne N. Hobbs, OD

Disclosures

March 18, 2019

Clinicians are aware that patients withhold information, at times critical information, but this inconvenient truth is often overlooked or ignored. Sometimes, patients may even lie to their healthcare providers. It is a difficult topic to evaluate, but nondisclosure of health information has a significant impact on the care a patient receives. It is valuable for clinicians to have a realistic estimate of the frequency of omission and the reasons patients fail to disclose information so a better environment of care can be created to facilitate more open and honest communication. Clinicians make decisions on data, but treatments can be only as accurate as the data used to generate them.

Recently, there has been an emphasis on patient-centered care and the need for cultural competence, but how are providers really doing? Do patients feel the exam room is a safe space that invites an open dialogue with their provider, free from judgment and criticism?

The Surprising Reasons Behind Many Patients' Nondisclosure

Levy and colleagues[1] led a research study seeking to specify which information patients are most likely to withhold and to identify the most common reasons for nondisclosure. An online survey was developed by a group of physicians, psychologists, health service researchers, and the lay public. The survey inquired about seven types of information regularly withheld and investigated the most common reasons for nondisclosure. The survey was disseminated to two samples of internet users. One target group of respondents was identified from previous participation in surveys and the other group was a more diverse panel affiliated with Survey Sampling International.

Of the 4510 total participants, approximately 70% admitted withholding information from their healthcare providers. The most common information withheld was unexpected—disagreeing with the clinician's recommendations. Over one third of patients had disagreed with their healthcare provider but had ultimately failed to communicate their feelings. The second most common type of nondisclosed information was failure to understand the clinician's recommendations. Approximately 20% of patients did not take medications as prescribed and failed to inform their providers. The patients most likely to need medications—those with chronic illnesses—were the least likely to be completely straightforward with their providers. Avoidance of being lectured or judged was the primary reason patients did not share information with their providers. Similarly, unwillingness to hear how harmful their behavior was and the fear of embarrassment were two other commonly cited reasons for nondisclosure.

"The most common information withheld was unexpected—disagreeing with the clinician's recommendations."

How Can We Do Better?

The information patients fail to disclose is perhaps unexpected, but the reasons for nondisclosure represent the greatest opportunity for improving patient care.

Nearly 1 in 5 patients reported a previous negative experience with a provider as a reason for withholding information. Fear of being labeled difficult or unintelligent was another major motivator for withholding information. Hesitancy to take up more of the provider's time and the desire to be liked were two additional reasons for nondisclosure.

These statistics provide evidence that we are not creating a safe environment for patients or cultivating an open dialogue. Most reasons patients were not completely honest with their providers were connected to the provider's reaction or perception of the patient; fortunately, this means that providers have the potential to change this dynamic.

There are no magic solutions to this issue of nondisclosure. Vulnerability is embedded in both sides of the doctor-patient relationship and this complicates the ability to give and receive information. A small step toward empowering the patient might include simply asking if they agree with the treatment plan rather than if they have any questions, because the latter implies the treatment plan has already been finalized. Another step might be making intake forms more inclusive to foster a sense of acceptance and safety from the moment the patient enters the office.

Evidence-based medicine is dependent on the quality of evidence, and ensuring that complete and accurate information is received from the patient is an essential element in providing the best care.

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