Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Truth: The Whole Truth

truthTruth: A patient contacted me with a specific request for pain management. He had read an article on a process to deal with chronic pain, and he, like his mother, suffered from diffuse pain which someone had diagnosed as fibromyalgia.

In the intake process, he withheld a great deal of data regarding childhood trauma and incest as well as his own past drug abuse and promiscuity. With these data, I was compelled to ask him as to whether he was involved with women outside his marriage. He reluctantly admitted that he had twice done so, but that these had ended.

When placing a timeframe on the ending of the affairs, I noted that this was the exact timeframe of the beginning of his pain. The pain began to subside as he revealed more about his past, and the impact of trauma upon his life, the choices he has made and the goals he has not achieved.

Patients fail to tell us the whole truth, providing partial data, witholding valuable information and/or altering the information in ways that obstruct the treatment process. There are both errors of omission and errors of comission. Patients will omit data that are crucial to undetstanding them and provide inaccurate data meant to protect or enhance themselves.

Patients will self-select what they tell their primary care physician. Since office visits in such settings are, by necessity, brief and typically infrequent, the doctor will ask, and the patient will provide, just enough information to make a rapid diagnosis and treatment recommendation.

Unfortunately, payors sometimes correlate quality of data with the length of a report. In workers compensation, it is common to see multi-page reports that repeat old and irrelevant information without ever addressing issues that bear upon treatment and recovery.

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