What Patients Don’t Tell Their Doctors: The Dimensions of Nondisclosure
Recent studies show that patient disclosure is a moving target, especially when it comes to concerns of digital privacy. Read more from Dr. Steven Rigatti below.
The ideal doctor-patient relationship is one of mutual respect and trust, built up over many years. But due to time constraints, ever-changing health insurance provider panels, and the ever-present “Dr. Google,” this relationship has recently taken a hit. Despite this, doctors remain one of the most trusted professions in America, outdone only by nurses¹.
It has been long recognized that people tend to embellish certain aspects of their health such as exercise habits and diet, while minimizing others like smoking and alcohol intake. A recent study in JAMA² evaluated surveys given to two patient groups, one younger (average age 36) and one older (average age 61). About 81% of the younger group and 61% of the older group admitted to withholding information. Specifically, 24% of the younger group and 20% of the older group admitted to withholding information about their unhealthy diet, and a similar proportion withheld their lack of exercise. The most frequent type of withheld information was disagreement with the physician’s recommendation (45% in the younger group, 31% in the older group). This study further found that women, younger people, and those with worse self-reported health were more likely to withhold information.
While this is interesting, it would be more relevant to insurers to know how often individuals fail to disclose important mortality-associated factors like smoking. Prior studies³,⁴ have shown that 8–12% of smokers do not admit their habit to their doctors. In the context of a medical visit this is an understandable human reaction: avoiding the doctors’ anticipated negative reaction and advice to quit.
A newer element in the doctor-patient relationship is the electronic medical record (EMR). The proliferation of EMRs, coupled with many high-profile news stories of data breaches and medical identity theft⁵ have sown additional seeds of mistrust. Even if a patient fully trusts their doctor’s medical judgment, can he or she necessarily trust that doctor’s IT security protocols? They certainly don’t teach that in medical school.
Some researchers have become concerned enough about this issue that they sought to determine how common it was for patients to withhold information from doctors based on concerns of privacy and security. A recently published study in the Journal of The American Medical Information Association⁶ analyzed survey data from over 3,800 respondents and found that roughly two-thirds of individuals were concerned about the security of their medical records. Further, about 12% of respondents said they had withheld information from their doctor to avoid having this information potentially exposed.
We see from the above that patients have a natural tendency to avoid certain sensitive disclosures, and that the digitization of healthcare has likely worsened the situation. Research at CRL has demonstrated that, among those who deny smoking on their laboratory slip, approximately 3.6% are found to be positive for nicotine metabolites in their urine. Further, among those defined as smokers (admission of tobacco use or positive urine cotinine), only 68% actually admitted it on their laboratory slip, meaning that fully a third of smokers were only discovered upon testing. Therefore, insurers who rely on smoker self-disclosure, whether it be in the medical record or on the lab slip, would likely miss a substantial proportion of smokers.
If you have more questions on this topic or have requests on future subjects for the CRL expert team to discuss, please email ILSblog@crlcorp.com.
-  Brenan, M. “Nurses Again Outpace Other Professions for Honesty, Ethics.” Gallup News. 20 Dec. 2018.
-  Levy AG, Scherer AM, Zikmund-Fisher BJ. Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians. JAMA Network Open. 2018;(7):e185293.
-  Curry LE, Richardson A, Xiao H, et al. Nondisclosure of smoking status to health care providers among current and former smokers in the United States. Health Educ Behav 2013;40:206–73.
-  Stuber J, Galea S. Who conceals their smoking status from their healthcare provider? Nicotine Tob Res 2009;11:303–7.
-  Davis, J. “The 10 biggest healthcare data breaches of 2019, so far”, Health IT Security. Accessed 2/25/2020.
-  Agaku IT, Akinyele OA, Olalekan AA, et al. Concern about security and privacy, and perceived control over collection and use of health information are related to withholding of health information from healthcare providers J Am Med Inform Assoc 2014:21:374–378.
About the Author
Dr. Steven J. Rigatti is a consulting medical director with Clinical Reference Laboratory, with 12 years’ experience in the life insurance industry. He is the current chair of the Mortality Committee of the American Academy of Life Insurance Medicine.