History taking and communication between patient and clinician are vital, fundamental aspects of a successful episode of health care. According to multiple studies conducted in a variety of health care settings, physicians were able to correctly identify the diagnosis for 75-85% of patient encounters based solely on the history portion of the examination.1,2Skilled clinicians should have the medical knowledge to determine the appropriate progression of questions needed to elicit important medical details for differential diagnosis. However, recent evidence suggests that a substantial proportion (61-81%)2of patients withhold important information from their clinicians. This phenomenon of patient non-disclosure poses a significant risk for clinicians’ ability to accurately diagnose and provide appropriate patient care.2

 

What information is most commonly withheld?

According to a survey regarding patient disclosure of information to clinicians, respondents reported intentionally withholding information from their health providers most often when the person disagreed with the clinician’s recommendation, or misunderstood the clinician’s instructions.3

 

Why are patients withholding relevant health information?

In the same survey mentioned above, the researchers also explored the reasoning behind why patients are not disclosing certain information to their clinicians. The most commonly reported reasons for non-disclosure included not wanting to be judged or lectured, not wanting to hear how harmful the behavior is, being embarrassed, not wanting the clinician to think that they are a difficult patient, and not wanting to take up more of the clinician’s time.3

 

Who is most likely to withhold information?

Survey participants with increased rates of concealing information were women, of younger age, and those with lower scores of self-rated health.3Thus, the individuals in worse health who are in greater need of medical attention are the ones more likely to not disclose important health information to their health care providers. This occurrence compromises validity of the patient interview, and disrupts the clinician’s ability to gain a full and accurate depiction of the individual’s health. Ultimately, non-disclosure of relevant information may contribute significantly to misdiagnoses, inaccurate condition/disease management, and increased rates of adverse drug events.4

 

How can clinicians achieve more open and honest discussion? 

Professionals in the field and researchers alike agree that one of the most effective methods to increase patient disclosure lies in the clinician’s ability to empathize and make the patient the patient feel comfortable. It has been shown in numerous studies that the patients are more likely to disclose information if they trust their clinician, which improves the overall quality of patient-clinician interactions.5High levels of trust have also been associated with a perception of better overall care.6The results of studies such as these highlight the value of interpersonal trust between healthcare provider and patient. Now that you have been made aware of this issue, it should be apparent how the health care system can be negatively impacted when trust is not well established and withholding of information occurs.

 

References:

  1. Goodman CC, Heick J, Lazaro RT. Differential Diagnosis for Physical Therapists: Screening for Referral. 6th St. Louis, MO: Elsevier Saunders; 2018.
  2. Ohm F, Vogel D, Sehner S, Wijnen-Meijer M, Harendza S. Details acquired from medical history and patients’ experience of empathy – two sides of the same coin. BMC Med Educ. 2013;13:67. doi:10.1186/1472-6920-13-67
  3. Levy AG, Scherer AM, Zikmund-Fisher BJ, Larkin K, Barnes GD, Fagerlin A. Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians. JAMA Netw Open.2018;1(7):e185293. doi:10.1001/jamanetworkopen.2018.5293
  4. McCarthy K. Study: 50% percent of patients withhold information from their doctor. Nuemed.com. https://www.nuemd.com/news/2014/12/19/study-50-percent-patients-withhold-information-their-doctor. Published December 19, 2014. Accessed December 26, 2018.
  5. Maria A, Chaar C. How to build and maintain trust with patients. Pharm J. 2016;15. https://www.pharmaceutical-journal.com/pharmacy-learning-centre/how-to-build-and-maintain-trust-with-patients/20201862.article. Published November 2016. Accessed December 27, 2018.
  6. Birkhäuer J, Gaab J, Kossowsky J, et al. Trust in the health care professional and health outcome: A meta-analysis. PLOS ONE. 2017;12(2):e0170988. doi:10.1371/journal.pone.0170988