Everybody (well, almost) lies ... to their doctor.

• Author: Klebanow, Diana
• Position: Medicine & Health

"EVERYBODY LIES," was the mantra of diagnostic genius Dr. Gregory House on the long-running hit television series about an exceptional physician whose character was modeled after the great detective Sherlock Holmes. House indeed was wise in the ways of his TV patients. Real-life doctors are well-advised to take the same approach. Deception about drug use--in addition to lying about other matters relating to health is not uncommon. Many physicians have come to expect that patients not only routinely will not tell them the truth concerning drug use, but about matters including alcohol intake, smoking, exercise, diet and sexual behavior.

In a 2009 article in The Primary Care Companion to the Journal of Clinical Psychiatry, physicians John J. Palmieri and Theodore A. Stem stated that patients lie to avoid negative consequences, to achieve secondary gain--such as individuals seeking disability payments for feigned illnesses--and to escape embarrassment or shame. In an effort to detect these falsehoods, some doctors have proved to be resourceful.

Writing in The New York Times on Jan. 7, physician Haider Javed Warraich admitted that he and many of his colleagues regularly look up their patients on the Internet in order to find out if they have left out pertinent information. He cited an instance in which he was treating a frail elderly patient with labored breathing. Warraich ordered a drug screen to see if the problem was caused by accidental ingestion. It came back positive for cocaine. While the patient stated that she had no idea why cocaine was present in her system, a subsequent search by a nurse on "MugShots.com" revealed that the patient had been detained by authorities three decades earlier for cocaine possession. The patient eventually improved in the course of her hospital stay, and was discharged.

It could be argued that, because the use of recreational (or illicit) drugs like cocaine is against the law, the patient was unwilling to admit to using it. On the other hand, health care professionals are pledged to confidentially regarding their patients' records.

Emergency room physicians, working under time constraints and heavy patient loads, need to deal with a wide range of problems. One of them includes having to identify patients who come for the sole purpose of obtaining drugs, in contrast to those who seek them for legitimate means. The former group includes recreational drug abusers, addicts who are unable to curb their drug-seeking habits, and the so-called semi-addicts, whose chronic pain has not been treated appropriately.

Emergency department physicians are hardly unaware of the dangers posed by overdosing on prescription...