Patients don't always disclose the whole truth. Sometimes, we tell outright lies. I was sitting with a friend of mine who is an acupuncturist. We were at Starbucks discussing a project we were working on together. I wasn't feeling particularly well. My friend asked if he could take my pulse. As he felt my wrist, he asked me a few questions, which I answered truthfully. He spoke quietly, cognizant of the fact that we were in a public place. I'm sure no one around could hear. Then he asked, almost half to himself, "And your bowels? You've had loose stools recently?" Of course I said, "No."
When we got back to the car, I wanted to smack him and say, "You don't ask a woman about her bowel movements in a Starbucks!" It wasn't that I thought anyone had overheard us, but the principle of the matter that irritated me. Bowels are not a polite topic of conversation. However I was unwell and wanted the best treatment I could get, so instead I sheepishly said, "You know I lied about my bowels." To which my friend smiled and responded, "It's OK All patients lie."
Half-Truths
A half-truth is a failure to fully divulge facts or information in an effort to evade blame or hide from responsibility. I usually feel compelled to tell my health care providers half-truths when they ask about issues regarding compliance. With the exception of taking herbs as prescribed, my efforts at compliance with what various acupuncturists have suggested is only mediocre. For example, one acupuncturist continually asked me if I had given up cold foods, to which I generally responded, "I try." That was partially true. If the cold food was not ice cream, I might consider whether or not to eat it. If I defined food strictly as solid, not liquid, I didn't have to confess to the fact that I only consumed milk, water, juice and soda that were ice cold. I know my acupuncturist knew I wasn't telling the whole story, but I felt foolish affirming that I had not complied with the suggestions.
Actually, I resented the question being put to me. I was sure the acupuncturist already knew that I had not complied, so why put me in a position that forced me to tell a half-truth? I'm an adult; I do not want to be admonished for my failings. I comply as best I can. One of the reasons I stopped seeing that acupuncturist was because I felt like she had too many expectations of me. Seeing her sometimes made me feel like a misbehaving child who couldn't earn her mother's approval. I found another clinician who accepts me as I am.
My current acupuncturist does not ask for compliance. As he explained it to me, he believes that as my treatment progresses, I will make better decisions on my own; he need not direct me. I have found this to be the case. For example, I was told that I should go to sleep earlier, but try as I might, I could not. After seeing my acupuncturist for a brief time, I suddenly found myself becoming sleepy at a reasonable hour, going to bed at a respectable time and sleeping through the night. The change occurred on its own. Because my current acupuncturist does not make demands I cannot meet, I feel no need to be cagey in my responses to his questions. His acceptance of me allows me to be open with him and share information that allows him to help me.
Omissions
An omission is a failure to disclose information. Children of all ages are masters at lying through omission. How many times have you asked a child a question and gotten the response, "I don't know?" You know full well that the child has information, but they aren't going to share it. That is a classic case of omission.
Lying by omission has been particularly difficult for me to overcome. My failure to share critical information with my acupuncturist has nothing to do with an overdeveloped sense of privacy or some strange desire to impede his efforts to help me. Most of the time, when I omit details from my response to a question, it's because it simply hurts me too much to put the information into words.
When I first started seeing my current acupuncturist, he asked if I would allow a colleague of his to ask me a few questions. I assumed that this would help him with his diagnosis and agreed. The colleague, a gentle, unassuming man, introduced himself and asked me a few questions. I answered truthfully and completely. He then asked me about a particularly traumatic event in my life. I tried to form the words to answer him, but I could not. I sat and sputtered for what seemed like an eternity, but was probably two minutes. I looked desperately to my acupuncturist for help. I finally got out only a tiny bit of what had been asked for and, exhausted by the effort, could do no more. It didn't matter; I had shared enough for them to make their assessment.
Not all patients lie by omission for the same reasons. Usually though, there is an emotional motivation for the omission. Whether it is fear, shame, a desire to save face, or something else, omissions tend to point toward deeper issues than the question being asked.
Lies
Falsehoods or outright lies are the most straightforward to identify. They are a blatant misstatement of fact. Patients tell lies for all sorts of reasons. When I lie, it is usually to garner approval. I want my acupuncturist to know that I am doing the best I can to help him help me, and so I might sometimes be tempted tell him what he wants to hear rather than the truth. I also don't want to be embarrassed in front of my acupuncturist. As I did with my acupuncturist friend, I am prone to lie if I feel self-conscious.
My current acupuncturist doesn't put me in situations where I feel compelled to lie to him. If he senses he's getting too close to a subject where I might withdraw or lie, he asks me if he may query further. At other times, if I feel that he is getting too near a topic I don't want to discuss, I tell him so. "Let's not go there," is our code for, "If you force me to tell you more, I'll have to lie to you." Respectfully, he retreats. Interestingly, his willingness not to force me into lying has usually meant that when I next come in for treatment, the information he wanted comes tumbling out and my treatment can progress in what is often a dynamic way.
I don't believe that most patients want to give their acupuncturists half-truths, omissions, or lies. I certainly recognize that doing so prevents my acupuncturist from providing me with the best, most effective care possible. I therefore deeply appreciate his efforts to place me in a space that allows me to be as honest as I can be without feeling embarrassed, like I can't meet his expectations, or that I am judged. It is the mark of a talented acupuncturist who can provide his patients the confidence and support to tell him the truth.
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