How can you tell if a patient is misleading you?
The patient may be malingering, lying, or exaggerating about the extent of their injuries. Detecting the occasional malingering patient can be difficult. 
The physician relies on the patient’s complaints in order to treat the patient. Verbal communication with the patient is important. The patient may attempt to mislead the physician for personal gain such as with workman’s compensation claims or car accidents so they can take more time off or gain more compensation.
Sometimes, patients may allege that they are experiencing a lot of pain and weakness or that they have lost their pain medication in an attempt to get more drugs. The physician may find disparity between the patient’s explanation of the injury or condition and the actual findings during the physical exam.
Overreaction to pain is another finding. The patient may exaggerate the condition and overreact during the exam. This can take the form of extreme facial expressions, sweating, or verbal responses.
Research shows that communication can be verbal or nonverbal and that it is also possible to tell if someone is lying to you based on their body language. Verbal communication accounts for only 7% of the communication. How a person sounds when they are speaking accounts for 38% of communication and body language accounts for 55% of communication. Body language plays a big role in intuition. Body language gives us a message about what the other person is thinking. It is important to interpret the patient’s body language in order to determine if they are misleading us.
Body language involves:
- Eye contact
- Facial expressions
- Gestures
- Posture and stance
- Space relationship
Although physicians are very good at interviewing the patient for medical reasons, they may not be good at interpreting a patient’s body language. Verbal communication is important however, nonverbal communication is more important. Facial expressions and gestures can be useful for doctors when they suspect that the patient is not telling the truth. There are many experts who claim they can detect if a person is in fact lying to them.
Here are some of the observational cues if the person is lying:
- Hand to Face Gestures
- Playing around with their mouth or couch the side of their nose.
- They may be actually wanting to cover their mouth which comes from childhood—similar to covering the mouth to cover a lie.
- Playing with a shirt collar is also a cue.
- Rubbing the back of the neck—this gesture may be done similar to the way a mother would rub that back of a child’s neck to provide comfort to a hurt child. Questions may cause the patient discomfort and rubbing the neck gives the patient comfort. The patient may not be doing these self-comforting gestures throughout the meeting, rather, only when certain questions are being asked.
- Avoiding Eye Contact
- Occurs suddenly
- May signal that the patient is not telling the truth
- How the patient uses their feet and legs
- It is also important to take note of when the patient is seated.
- The patient has freedom of the use of their legs so watch for rocking or fidgeting motions with their legs in response to certain questions.
- The legs and feet are the furthest away for the brain and hardest to control
- How the patient uses their hands
- The patient will typically remain with the hands open when relaxed
- During certain questions the patient may begin to place their hands in their pockets, behind their back, or under their arm pits.
Look for these nonverbal signals that the patient is uncomfortable. This may suggest that the person is misleading you. It may not be difficult to notice the signs of a patient lying once you learn to recognize these cues.
Dr. Nabil Ebraheim's Blog 