Seven years later Charles and Eddie released what proved to be their biggest hit, asking the same question. And in 2007, a British TV game show with this name pitted two teams against each other, each trying to ascertain if a statement was fallacious or not, and this format was adapted for Australian and American audiences in 2022.
Clearly, we are attracted to the concept of veracity, and this moral compass is embedded in the Bible, where the ninth commandment states that bearing false witness against your neighbor is not acceptable; code for “thou shalt not lie.” We teach our children that lying is not acceptable, our legal system assumes innocence until guilt is proven and relies on witnesses telling “the truth, the whole truth and nothing but the truth,” and to ensure perjury is an unattractive choice, we ask people to swear to this and impose penalties for being dishonest. Given this background then, why is it that so many willfully choose to tell their physicians an untruth? Apart from descending into a moral abyss induced by telling a lie, are they unaware of the consequences? They may not be hauled off to the slammer, and possibly do not think their deity is listening. But the sequelae might be very serious, even deadly.
The relationship between doctor and patient is built on a foundation of trust; the patient trusts that the physician has the relevant skills, is listening to their concerns, will attend to their needs, and will hold everything they hear in total confidence. I love the description of trust that is shown by patients for their surgeon: “You are going to put your faith in this person such that you will strip naked, allow yourself to be strapped to a cold metal table, be paralyzed, surrounded by masked strangers—and they have knives!” And what do we doctors trust you to do? Two things: tell us the truth, and adopt what we agree is the right course of action to treat what ails you. That’s it.
But patients routinely lie to their healthcare providers; why might that happen? Maybe embarrassment, a sense of denial, to avoid being “lectured,” or fear of judgment. And for pilots, fear of losing their flight privileges! Could we do better to explain why the truth, the whole truth and nothing but the truth is important? Probably. But the data show this is a significant issue. In two national online surveys of 4,510 Americans, between 60 and 80 percent admitted they had not disclosed significant health information in seven different situations. The greatest number was because they did not “agree” with the doctor’s advice, and roughly the same number did not understand what they were being told and rather than ask, said they did. And around 20% fibbed to the doc about things like diet and exercise lifestyle. Women, younger people, and those dealing with more serious health concerns were, astonishingly, more likely to withhold or misrepresent information, and the problem seems to be getting worse. Recent data shows that while 69% of Baby Boomers (born 1946–1964) feel “comfortable” chatting with their doctor, that dips to 59.1% of Gen-X folks (born 1965–1980) feeling the same way, down to 52.4% for the Millennials (born 1981–1996), and only 51.8% for the Gen-Z crowd (born 1997–2012).
Another study from the early 1990s showed that a massive 85% of patients admitted that they had either hidden, or massaged, the truth. A recent survey of folks covered by Medicare Advantage plans discovered that nearly 50% lied about things such as their diet, exercise regime, sex lives, or adherence to treatment, and in this study, if the doctor was younger or male they were more likely to hear untruths.
To be fair, my profession can do better—a 2012 Health Affairs study found that of nearly 1,900 doctors, more than 55% admitted to sometimes discussing a patient’s condition in an unduly positive manner, which can compromise how seriously the patient will then take the doctor’s advice!
As doctors, we are trained to some degree to take what is said with a pinch of salt, and not just for a margarita. The old aphorism states if you want to know how many cigarettes a man smokes, double what he tells you and half what his spouse says. This, and other misrepresentations about lifestyle habits, family history, symptoms experienced, or medication regimes adhered to can have serious health consequences. For instance, the patient who was admitted to the ER having nearly bled out from vomiting blood was transfused and investigated for a cause, but doing so in the dark about his family history of hemophilia, a condition that could have been rapidly addressed. Or the patient neglecting to report rectal bleeding, a symptom suggestive of an early, and highly treatable, rectal cancer. Or failing to take prescribed medication for high blood pressure, leading to an otherwise preventable heart attack, stroke, or kidney failure. As above, it is important to understand that these behaviors are inspired by a complex range of thoughts and ideas, not merely being a deceitful individual.
However, for pilots there are other possible sequelae that can also be fatal. Yes, we all want to keep our ticket, and some have chosen to not report the rectal bleed or have the screening colonoscopy in case it reveals something that could be a problem for left-seat privileges. But if not taken care of, it is not just the left cockpit seat that will go empty, it could be every seat you will never again occupy. A polyp in the bowel can be easily removed via a scope, and if not malignant one can fly rapidly thereafter. And even if one finds a cancer, the earlier this happens, the more likely it can be cured.
Another situation is where a pilot is taking medications that are not allowable by FAA instead of discussing options with their physicians or sorting out the medical problem by lifestyle changes. After all, if one loves flying so much, surely one can make certain sacrifices?
I know many aviators get bent out of shape as to why a drug can be licensed by the FDA, be widely prescribed, yet not allowed by the FAA. Let me endeavor to explain this. A new medication has to go through extensive and rigorous experiments for many years to demonstrate safety and efficacy, a process I described earlier this year in my article, Do Parachutes Prevent Injury? After initial evaluations, a series of Phase III clinical trials are held where a drug is administered either in comparison to a placebo (a biologically inactive compound) or an alternative treatment. Such trials cost millions of dollars, can take several years, and typically include 300–3,000 patients with a tightly defined manifestation of a disease. Once approved for use in the USA by the FDA, it might be used to treat tens or hundreds of thousands of patients in the first year or two, many of whom might not have met all the criteria to be included in the clinical trials, and this can surface new and sometimes unexpected side effects. This, together with any obvious side effects that might impair flying, are closely monitored by FAA and may, eventually, be cleared for use by pilots.
In Stan and Jan Berenstain’s 1984 book, The Berenstain Bears and the Truth, a book I read to my children, a lamp is broken by the youngsters while playing with a ball indoors. Scared of the consequences of admitting that they were breaking the rules leading to the accident, they start to fabricate a lie, which gets bigger and more fantastical. When the truth comes out, as it always does, the lamp is easily fixed but trust, once broken, is hard to mend. So, please help my colleagues and me to do our very best to keep you agile, alive, and aloft and tell us the truth, however ugly. Fly well!
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