Patients lie. That’s not a secret. It’s the reason doctor notes read like police reports. “The patient denies smoking.” “The patient states they lost the prescription for Vicodin that the ER gave her two days ago.” It would be kinder if we wrote “the patient doesn’t smoke” and “the patient lost her prescription” but do we know that to be true?
Patients lie routinely about their diet, their exercise, their intake of alcohol or recreational drugs, their sexual activity, their smoking, and their adherence to medications and doctor orders. Whatever the reason for lying, sometimes, these lies sabotage their health.
On the tail-end of the Ebola crisis, I was consulted for fevers and weakness in a patient who claimed to have traveled from a different state to mine to visit family. Blood smear showed parasites. It was the weekend so we would have no confirmation of pathogen until Monday. Travel history was elicited from patient and then from family. No, no, we haven’t been out of the country. It’s been a few years at least. So I begin treatment for babesiosis. The next day, Monday, the pathologist identifies the parasite as Plasmodium falciparum, the agent of malaria. Surely, the pathologist is mistaken. I marched to pathology to look at the slides now available. If the parasite was indeed plasmodium species, could it be P.vivax, one of those known to cause recurring malaria many years after acquisition?
After all, the patient denied any recent international travel. They would be dead if they’ve had falciparum malaria since their last international travel, years ago. Either that or there’s about to be a CDC investigation into local transmission of falciparum malaria in the continental USA. In the end I could not refute the evidence that lay before me when I peered through the microscope. This was Plasmodium falciparum! The patient has malaria! There is a patient with malaria who is in the hospital and has not yet received anti-malarial medications. I was mortified. Falciparum malaria can be deadly if not diagnosed and treated in time. When I approached the patient/family, they replied that they didn’t think recent travel to West Africa (as in just returned from) was relevant. As a fellow African, I understood that they did not want to be stigmatized as having Ebola, but as a physician I was furious that I was led down the path of misdiagnosis.
Patients have their reasons for lying. But lying can lead to disastrous results. Luckily, this patient did well.
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