Not too long ago, a student asked me how do I know whether my patients are telling the truth during history taking.
Truth of the matter is, I don’t.
But experience has taught me to look out for certain tell-tale signs that a person may not have been entirely truthful. This is especially pertinent in HIV-medicine because the disease, 30 years on, is still very much a stigmata and taboo subject.
People want to avoid the truth because it is unpleasant.
I can recognize at least 4 types of half-truth or plain-lies tellers:
1. The vividly-detailed-story
Usually, in a crisis situation, things would happen so fast that the typical response of a person who has undergone the situation will be “It was all a blur”.
Not so for this patient whom I saw many years ago. This was how he told his story:
“I was at the parking lot of this (sic) shopping mall when suddenly a man in his late 30s appeared out of nowhere! He asked me for money and in his right hand, he was holding a 5 cc syringe with a 25 gauge needle. In the syringe was blood which the man claimed to be his blood and that he has HIV infection. When I refused him money, the man assaulted me and stabbed me with the needle which poked my left elbow before fleeing the scene! I could not retrieve the needle and syringe because he took it with him before fleeing!”.
Yeah, right…..
2. The coached-to-tell-a-story type
Sometimes the words that come out of the mouth of a patient are so incredulous, it’s impossible to be the truth. Like the words of a young underage girl who presented in advance pregnancy:
“Before you start your examination, I want to say clearly that I had sex with my father and I did it willingly!”, she said in a well-rehearsed poker face!
Yeah, right….
3. The in-denial-type
A patient, anxious to hide the truth, might offer more than necessary information, even information that is unasked for. Like the young man who was fairly recently diagnosed with HIV-infection from blood donation.
He came into my clinic room and before I could ask him anything, he blurted out:
“Doctor, I really don’t know how I got this infection. It’s impossible! I mean, I have never had sex. I have never had any blood transfusions and I never ever do drugs!I think maybe I got it from other people’s blood because I like to help victims of road traffic accidents.”
Yeah, right….
4. The fantasy-weaver
This type is simply not from this world. Like the guy who was diagnosed with both syphilis and HIV-infection during a routine health check who, without a hint of being aware of how ridiculous he sounds, said this:
“I believe I contracted these disease from the polluted air around me”!!
Yeah, right….
But really, whatever was the cause or origin of their infections, to me it does not matter. My job is not to dwell on HOW they got it but HOW to get them well and to keep them healthy.
So, whenever I get stories like these from patients, I don’t even raise an eyebrow. I simply nod my head and move on. 
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hehehe love the “yeah right” …lol
In my field though, I often need to know how they got into the current state for me to manage them properly. Eg. 50 year old who presented with acute on CKD. If he refused to tell me he had been taking a herbal concoction for the last 1/12, I would be left searching high and low for a precipitating cause.
That’s true. Each specialty has its own unique challenges.
I think this is such a great post and timely too if I may add. As what Dr. House always say, everybody lies. As doctors, it is indeed our duty to treat and find out the underlying cause for the illness in the patients however, to come to that, we have to inevitably unravel certain truths, in which, most of the time they can be quite unpleasant to the patient.
And I can’t agree more to your statement of ‘My job is not to dwell on HOW they got it but HOW to get them well and to keep them healthy.’ That’s our job really and not to be busy bodies. Cheers!
You said:
“…whatever was the cause or origin of their infections, to me it does not matter…”
I agree in general with your statement. It’s none of our business and we must not be judgemental in delivering care.
There are 2 exceptions though:
1. In case 2, you have a duty to protect the young ones. Esp if you think they are being exploited. Same applies to anyone who are deemed vulvenrable.
2. Contact tracing to protect the public
I agree with you. In case 2, I omitted the fact that the patient was brought to the hospital by the police. Evidently some one has already made a police report. As for contact tracing, I hate to say this but many a times it’s rather laughable how this is done in this country. Still, the cases I quoted here are the extremes. More often than not, it’s rather easy to determine the truth and discover who else are exposed. Finally, even if I suspect the patient may not be entirely truthful, how do I get the truth out of them? Confront them? The very act of confrontation may actually backfire and cause the patient to default future follow-up, to the detriment of the patient’s health.
well, sometimes, ppl down on their luck may want to believe their own made up world