Detecting the Liar
Discerning Lies Can Be Challenging
According to Scientific American Mind, lying “is among the most sophisticated accomplishments of the human mind.” It requires cognitive skills that children are not born with and must acquire. Our ability to lie seems to improve until we reach young adulthood, and then it levels off. Once we reach about age 45, our ability to lie declines.
Discerning the difference between truth and lies seems to be even more challenging than telling a lie. “Truth isn’t truth,” according to former Mayor Rudolph W. Giuliani. Although we have become accustomed to hearing politicians say untruths, the problem of lying extends far beyond politicians.
Polygraphs were invented in 1921 as a better way to interrogate suspected criminals and get at the truth, but the machines’ scientific validity has always been questioned. It seems that neither people nor machines are especially good at knowing the difference between truth and falsehoods.
Doctors Can Be Tricked by Lying Patients
Beth Jung, EdD, MD, MPH and Marcus M. Reidenberg, MD point out in a Pain Medicine article titled “Physicians Being Deceived” that doctors, too, have difficulty determining when their patients are telling the truth and when they are not. Jung and Reidenberg believe doctors who are uncertain about whether or not patients are telling the truth when controlled substances are involved may err on the side of withholding medication.
Unfortunately, some patients may try to trick their doctors into prescribing medication, because they want to use the medication for a nonmedical purpose. Doctors who believe some of their patients are lying are less inclined to believe any of their patients. Additionally, they are less likely to sympathize with their patients’ pain for which the medication is intended. That can make it more difficult for honest chronic pain patients to get the treatment they need.
Jung and Reidenberg researched several high-profile cases in which doctors were prosecuted by the Drug Enforcement Administration (DEA) for prescribing opioids to non-cancer patients. In some of these cases, doctors had prescribed opioids to undercover DEA investigators who claimed they needed medication for pain. The DEA then alleged that these doctors should have known the investigators were lying about their pain.
In a Pain Medicine article, “Pain, Patients, and Prosecution: Who Is Deceiving Whom,” Stephen J. Ziegler, PhD, JD, Assistant Professor of Public & Environmental Affairs at Indiana University-Purdue University, argues that doctors are not obligated to guarantee their patients are telling the truth or they are using their medication properly. He writes, “…just because a physician is deceived, the deception by itself will not incur liability.”
Prescribing With a Legitimate Medical Purpose
Licensed physicians, Ziegler says, are legally allowed to dispense controlled substances for a legitimate medical purpose. “In the event that a physician issues a prescription for a controlled substance that was the product of deception, that standing alone will not criminalize his or her action,” according to Ziegler. To get a conviction, the government would have to prove that the doctor “knowingly and intentionally” dispensed a controlled substance to a person without a legitimate medical purpose.
Unfortunately, physicians may not be convinced that Ziegler is correct. Furthermore, doctors who trust their patients are less likely to detect when their patients are being dishonest. Doctors often feel that their potential failure to detect a liar may put them at higher risk for prosecution.
On the other hand, law enforcement officials are trained to get at the truth by noticing nonverbal cues and other behaviors. They can be overly confident of their ability to detect liars. Because law enforcement officials believe they usually can tell when someone is faking, they expect doctors to be able to do the same. As a result, they often are willing to assign criminal responsibility to doctors who prescribe opioids to patients who do not need them.
American Journal of Law describes an attempt to determine if law enforcement officials were more effective than physicians in identifying whether people were faking their pain. Actors were recruited and sent into doctors’ offices. They also met with law enforcement officials. Patients with legitimate pain were also sent to visit the doctors and law enforcement.
The results showed that law enforcement officials were not able to differentiate the true patients from the fakers any better than the doctors. Doctors and law enforcement had about a 54 percent chance of detecting the liars.
While doctors need to be vigilant about prescribing controlled substances appropriately, they must be able to trust their patients. Punishing doctors for failing to detect dishonest patients holds doctors to a standard that is unrealistic. It also creates an adversarial relationship between the physician and patient that may result in compromised care. As American Journal of Law concludes, “there are disproportionate harms to encouraging suspicion of patients.”
Thank you for writing this article. The more education the better – even if it is very painful to read. This is horrible. As a pain patient I feel like everything discussed here is equivalent to saying all pain patients are basically in a court room (not a doctor’s office) being judged as to whether they are criminals or not. Often it is actually worse, many of us are treated like we are criminals the instant we mention chronic pain. The doctors are threatened and the doctor/patient relationship is destroyed. All of this hurts innocent people – patients and doctors. The DEA tricking doctors with their lies – that should be illegal and they should be punished. This entire system is sick beyond words. I feel like it is run by as sadist. It causes so many of us to feel so much anxiety that our health is compromised even farther – and there is clear scientific proof that not treating chronic pain causes many many medical problems and puts you at risk for many more. How many more of us have to commit suicide before things change?
Great post Dr. Webster. Some doctors DO have the ability to detect lies. I have CRPS along with other issues. I was away from home and underwent surgery and was given only a few Norco after my flesh was cut open. I had post-surgery pain and went to the ER and the young doctor I encountered acted like I wasn’t in pain when I was. As an older person who has never abused medication I went through a cacophony of emotions. Anger, shame, frustration. I left the ER and went home and almost committed suicide. The pain was unbearable and the last thing I needed was some snotty young doctor who never felt worse than a toothache paternalistically tell me I didn’t need relief.
When I returned home I went to a pain specialist. He happened to be friends with a relative and knew what type of people we are. He prescribed me medication in accordance with my serious medical records. When I needed it raised one time he said: “No problem I can tell who the bullshitters are.”
We now live in a throw away, disconnected society! Doctors for the most part don’t know their patients,and are NOT encouraged to know them, because of transference, the power hierarchy. If family members don’t know there is a problem; and they live with the person, how can doctors know? It takes time, if you don’t know a person, to be aware of clues that something is wrong. Doctors are not trained for that to be their first response. I wouldn’t go to a police officer for surgery, don’t expect doctors to be detectives. Doctors do have protocols for people who may have addiction problems. Protocols take time and so does Trust. Most doctors have 15 minute appointments now. If you only see a person for 15 minutes 1 or 2 x a month what do you know about them, other than what they tell you, an the point of the article is people lie!!