Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Liar, Liar

Monday, December 3, 2001

When a nurse case manager, feels as though the patient is witholding data or altering information, the frustration and resentment can lead to burn out.

If you feel your efforts are futile and that you no longer derive any satisfaction from your work and that your work is under appreciated, then perhaps burn-out does apply. However, perhaps the following will better help you understand what is occurring with the patients and that your work is not in vain:

As a nurse case manager (or adjustor, surgeon or attorney), the patients feel that there are specific data you are seeking and other data of which you would have little interest. Often, the patient does not even recognize the importance of unspoken facts.

Do patients lie? Of course they do. Do patients lie for the sake of money? Yes, that is part of any compensated disability process. However, if we define lying as deliberate withholding or distorting of data, there may be some other explanations which bear examining.

Patients often feel that if they revealed some data, respect for them would be lost, and efforts to assist them would cease. This can include anything from holding a job while receiving benefits to lesser issues such as their sexual preference.

Patients also fear that any information they provide would be misunderstood, misconstrued and misreported.

Patients often do not understand the implications of their own behavior and do not admit to the behavior because it frankly frightens, humiliates or confuses them.

The other part of your question is a common one, and one that I am asked continually: to wit, why does a patient tell me and not tell you. The answer to that is deceptively simple – the patient believes that this is my role, that I cannot be offended by their thoughts, feelings or behaviors. Often they have long wished to tell someone/anyone about these private aspects of their life. Revealing these data and seeing its relevance to their disability claim is part of patient education and often occurs within the confines of an I.M.E.

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