Most, if not all, patients initially withhold data.
They may do so because they are afraid of being negatively judged. Or they may do so because the true will not provide them with the outcome that they want. Sometimes they do so because they cannot handle the true of their own lives.
Individuals are less likely to withhold to certain authority figures; priests are one example. Patients are less likely to withhold when they feel that lying may result in their needs not being met.
Most often patients feel that fabricating or withholding solves problems. They may lie to obtain more drugs, more time off from work, special exceptions and considerations_they lie because it works for them.
Why do patients lie less to one doctor versus another? There are many reasons but much of it has to do with the skill of the person asking the questions, something in the method that puts the patient at ease.
While patients can, and do, lie to me. They more often call back to give me information that they _forgot_ or avoided telling me when they saw me.
Not all such patients are dishonest. Many are merely needy and fearful.
You cannot extract the truth from the dishonest; all you can do is be certain that they are, indeed, being dishonest.
But with training and experience, you can obtain the truth from those who are hiding due to fear. This, however, cannot be accomplished in a 10 minute office visit in which the patient is there to be asked about their pain, have their medications refilled and to be rescheduled.
In order to obtain the truth, the doctor_s agenda needs to be set aside, and the patient_s agenda addressed. The patient needs to perceive that there are not time constraints or judgments associated with having the chance to tell the truth.