Why Patients Stop Telling Doctors the Truth

On shame, judgment, and what patients leave outside the room

A patient once told me, almost as an aside, that she had stopped taking a medication months earlier.

The chart said one thing. Her life said another.

For months, medicine had been treating the version of her that still existed on paper. She did not look defiant or careless. Mostly, she looked relieved to have said it. The medication had made her foggy at work. She had meant to bring it up sooner, but the visits kept moving along, the medication list kept appearing in the chart, and after a while the official version of her care had drifted away from what was actually happening.

“I didn’t want to get in trouble,” she said. That sentence has stayed with me because I hear versions of it all the time.

Not always in those words. Sometimes it comes as a joke, an apology, or a quick “I know I probably shouldn’t have…” before the patient says the thing they are worried will change how I see them. Sometimes it comes at the end of a visit, when the plan is nearly finished and the patient seems to d…