The role of prochlorperazine
Patient who tells you lies
It can be very unsettling when a patient starts to tell you lies, says Dr Melanie Wynne-Jones
You are unlikely to have reached your GPR year without having been lied to by the occasional patient.
But in general practice, where the doctor-patient relationship is supposed to be founded on mutual trust, discovering that a patient has lied to you can be annoying, upsetting or unnerving.
Lies are usually intended to benefit the liar, although sometimes the motive is altruistic.
The most serious lies are the ones where the stakes are high – for the doctor as well as the patient.
These may revolve around a patient trying to obtain prescription-only drugs, either to use themselves or to sell.
The patient may assure you that Dr X, who just happens to be on leave this week, promised that they could just come in and ask for extra diazepam if they needed it.
Your practice should have policies for dealing with these eventualities. If you suspect you are being lied to, tell the patient that you need to check practice policy first.
This has the advantage of deflecting any blame for not prescribing. You can thus express regret as you say no. However, this may not deflect the patient's anger or manipulative distress, and you may find yourself having to deal with these.
You may even find yourself having to deal with threats of violence. Occasionally patients looking for revenge may resort to malicious and unfounded allegations. If this happens, involve your trainer, your medical defence society and even the police if necessary.
Patients may also try to get you to legitimise their behaviour. For example they may ask for a retrospective certificate saying that they were too ill to appear in court.
Or they may ask for a medical report describing psychiatric illness or stress, hoping this will excuse them from criminal prosecution or help them to obtain benefits, compensation or early retirement.
The golden rule here is never to sign anything that you could not stand up in court and defend. Your professional reputation and livelihood depends on this.
However, a note stating 'Mr A tells me that he was ill on the day of his trial but did not consult me until today' is truthful and often seems to satisfy the patient, surprisingly enough.
You may also be surprised by letters from consultants quoting what patients have told them about your actions or the advice you have allegedly given them.
This can cause friction between primary and secondary care, although patients get it wrong more often than they lie.
It's worth remembering one consultant's advice: 'We won't believe everything they tell us about you, if you don't believe everything they tell you about us.'
Casual lies – 'I did ring to cancel my appointment' or 'The receptionist said you'd see little Johnny as well' or 'I'm too ill to come to the surgery' – seem to be becoming more common.
Obviously it is important to deal with the medical problem safely. But although it is tempting to turn a blind eye to save time and trouble, rewarding this behaviour can reinforce it and disadvantage other patients' care.
However, challenging patients' assertions can be hard work.
Who said what to whom can be difficult to establish, and confrontation may trigger a complaint or upset members of staff.
Discuss potential problems with your trainer before saying anything.
Fortunately, most patients are not malevolent deceivers, although some tell 'white lies' in an attempt to please or flatter us or to avoid looking foolish or difficult.
This can be the underlying reason for non-compliance/concordance or treatment failure. Look out for cues and try to give the patient an opportunity to tell you what they are really doing or thinking or hoping for.
Most practices knowingly accommodate some patients who are 'economical with the truth', partly for pragmatic reasons and partly because everyone has a right to medical care. But significant loss of trust can trigger an irrevocable breakdown in the doctor-patient relationship and may be grounds for removal from the list.
Under nGMS, GPs are encouraged to give patients a warning first, and to explain the grounds for removal.
Routinely documenting discrepancies verbatim as they arise will provide valuable evidence if the patient decides to complain or appeal.