What do you do when you believe a patient is not being honest about their symptoms?

Ask yourself, “why”? I had an idiopathic nausea-vomiting patient this weekend who (I believe) came in to use the hospital as respite care from her home life. I couldn’t fix her home life but I could help her feel cared for and seen and in a peaceful environment.

It is always important for the patient to understand that you are there to help identify ways to provide the best care possible. If I have reason to believe a patient is withholding important information or isn’t being honest, I find a way to explain that without accurate information, the care team cannot consider all of the options for treatment & could leave the patient with unidentified health issues. I might say something like, “I realize this can be a sensitive topic for some people and I apologize if it makes you uncomfortable, but I want to make sure we’re not missing anything that might help you feel better, so can you tell me about…”.

Document thoroughly.

most patients lie or aren't clear about their symptoms.
Our job is to write down what they say (S=subjective),
do a proper clinical assessment to confirm or deny ( O/A=objective/assessment),
then create a plan (Talking to the MD or NP would be the first step in the plan)

Remember when you ask an alcoholic how much he drank and he says, "I only had a beer?" In the ER, I would start watching him for hallucinations.