Liar, Liar, Pants on Fire

There’s an open secret in medicine: Patients lie. They lie about how much they smoke and whether they’re taking their medicine. They understate how much they drink and overstate how much they exercise. They feign symptoms to get appointments quicker and ask doctors to hide the truth from insurance companies.“Doctors have a rule of thumb. Whatever the patient says they’re drinking, multiply it by three,” said Dr. Bruce Rowe, a family doctor in suburban Milwaukee. “If they say two drinks a day, assume they have six.”

from http://www.msnbc.msn.com/id/17188153/

"There's an open secret in medicine". That caught my attention ... sounds like Clinton, obstetric, and scientific double-talk to me. An open secret would be known deception, if you ask me. And then the deceivER is calling the others liar. Do people reeeeeally lie? Is denial and self-deception really out and out lying? Who gets hurt the most when one lies to one's self. If patients lie about certain private information (as the story shares), can we say then that doctors out and out lie to us? Is that really lying? Or, just denial. Self-reporting is always likely to be exaggerated or minimized to fit the "norm." "Baby looks fine."

On the other hand, the use of cocaine and cigarettes are almost certainly major contributors to adverse neurobehavioral outcomes. But your proposed study will probably not work because you have no objective way of determining fetal exposure. Numerous studies have shown that self-reportage of use is unreliable and you need to have objective measures to verify the incidence and degree of cocaine and cigarette use.

-- personal communication from a researcher regarding my research proposal for evaluating the long-term effects of drugs during labor and birth by following babies' development comparing non-medicated and medicated birth. Recently, discuss sing the study that found high incidence of brain hemorrhaging in vaginal born babies, I suggested it would be a good study to assess and compare babies born at home without drugs and interventions to those in hospitals with drugs, mother supine, and interventions. This was my research proposal -- and he indicated that it would be impossible to look at the effects of drugs used at birth because women will under-report their prenatal drug exposure. So, then, just don't look at drugs at birth? When the majority of pregnant women will be adamant about no drugs during pregnancy, but believe doctors who say epidural anesthesia won't affect their baby. Did the researcher shoot me down because he didn't believe drugs at birth were a problem (as his communication did say) or was he just lying? Does he have a vested interest in not "rocking the boat" with medicine and big Pharm?

A lot of studies, I notice, make very sweeping claims like "Patients lie to doctors." Is lying actually the best word to use to describe the relationship between doctor and patient; medical profession and society? We could get into one of my favorite discussions about the dynamics of power -- and how it is in the medical system that one has to be very vigilant and self-protective. Every patient, especially pregnant women, cancer patients, and the elderly need an advocate with them all times. Most of the people I know feel the bigger problem is the inability to give or get adequate, accurate information from the physician.

As for self reports, having worked in drug treatment, I am aware of under- and mis-reporting of drug and alcohol use. However, the women I know who chose to have a homebirth do so very often in order to ensure they don't have drugs. It seems odd to me that women who are so intent on being drug-free during labor and birth would be women who drink alcohol, smoke cigarettes, and use any prescription or illegal drugs during the prenatal development. Most of them that I have known endure many painful injuries, ailments, and common colds, etc without any medications whatsoever.

I wonder what pregnant women "lie" about to their obstetricians. I was physically abused in the eighth month of my pregnancy and had a black eye. My obstetrician never even acknowledged it. My doting medical-student husband (later to become an OB) was there. And, do physicians ever deny, collaborate with lying to protect themselves (emotionally, mentally, financially) and each other? Or, to us? Like tell a woman -- sometimes in the first visits -- that her pelvis is to big or later that baby is too big (like Ann Nicole) to have to induce when the truth is s/he is managing her schedule?

If pregnant women deny their drug usage, how can doctors take into consideration the previous drug history of a woman if they don't know it? (By the way, isn't zero time three still zero?) What is the consideration for a laboring woman AND the laboring baby whose mother has know drug usage prenatally? Are there precise, science-based protocols for determing the "safe" dosage for mother, while keeping it "safe" for the baby (IF any drugs were ever shown to be safe, that is)? For example, if one watches Anna Nicole's Cesarean video, she clearly was not fully anesthetized. Was this because of her history of addiction (per reports of methadone during pregnancy) and her tolerance for drugs, so that a "normal" dose didn't work? Is she a liar or a drug addict? Which came first the liar or the addict? Is medicine, psychology, and religion to continue to deny/lie about the importance of prenatal, labor, and birth to the developing brain and body?

I think the medical profession should stop lying to themselves and to us about the promotion of epidural as safe and "natural" and all of the evidence-based science that clearly shows what is true. Maternal choice for inducing, epidural, or planned cesarean ain't the truth -- every time the doctor maneuvers a woman into "choosing" these interventions, there's a lotta lyin' goin' on. Both sides, baby.

Next time you go to the doctor, sit him or her down and tell the truth. See where it gets you.