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.”