How do you deal with a pt. who lies to you?

[RN student09]

I recently had a pt. who we were preparing for a planned surgery. She told me twice that she had had nothing to eat or drink. When she went back she admitted that she had been drinking water. The surgery was cancelled and the doctor and anethesiologist were furious at me!!!!!!!! How do I handle this?

[Dalzac, LPN, LVN, RN]

You can't really do anything if she keeps lying and the surgery keeps getting cancelled her Doc will end up sending her home. All you can do is write it up, put it on paper, and cya. Take away all cups water and do frequent room checks and document that you did that.

[stellina615]

Depending on the situation, a pt may not always fully understand why a certain piece of information is so important. So many things become routine to us and we have to remember that the vast majority of pts are not as well-versed in disease processes and procedures. Something like a pre-op NPO order is so automatic for those of us in healthcare, but for a pt who is likely to be ill and quite anxious, maybe going in for his/her first surgery ever, s/he may have other things going on in his/her mind that are more important than a sip of water. This is where the education part comes in. You did a great job by checking twice with the patient about what she had taken in. Next time, take your skills to the next level by saying, "the reason why I'm asking you this question is because if you do ABC, your health/safety could be at risk since XYZ." To give you an example, I had a patient in liver failure who kept refusing his lactulose. Needless to say, his ammonia levels were rising all the while and the nurses got so frustrated when we saw him start to get confused. It occurred to me to ask him why specifically he was declining the lactulose. His response? "Every time I take that medicine it gives me the $hi+s!" When I took the time to explain the importance of the lactulose, and how it correlated with the ammonia, he was more agreeable to it. Sometimes we nurses have to do some detective work too, and if your patient is still not forthcoming with the truth, just remind them that you're not a psychic and you can't to much to help them if they can't be honest about what's going on. I hope you find this helpful!

[diane227, LPN, RN]

People will lie to you from time to time and there is nothing you can do about it. Patients will hold back information for reasons known only to them. I had a guy once that refused to give us any of his medical history. He said it was our job to "figure it out".

[roser13, ASN, RN]

"He said it was our job to "figure it out".

LOL! I had one of those too, recently. She was married to a physician and didn't feel inclined to share any info with a lowly nurse. The anesthesiologist walked into the room (having been briefed by me beforehand) and the patient was all smiles and cooperation.

Anyone who's been a nurse for any length of time understands that there's a reason that 5 different people ask about allergies before the patient goes to the OR. That 4th or 5th nurse is likely to get an answer that the first 3 or 4 didn't get.

Working in pre-op, I agree that the main reason that people don't comply with rules is because they don't understand them. That just frustrates me no end. I don't know anything about auto mechanics but if my mechanic told me to do XYZ with my car to ensure good performance, I sure as heck would. I've had boyfriends/girlfriends/little children spill the beans on the patient regarding NPO status..."but mommy, you did so eat breakfast! You had pancakes at IHOP!" I was so angry at that one that I had the anesthesiologist come in and describe (in great detail) aspiration pneumonia. I have patients who refuse to remove rings/piercings, stating "oh don't worry, I'll just put a little tape over them." OK, well, if electrocautery is used in your procedure, you just might feel a little sting on that very sensitive private body part.

And some people are just plain dumb.....as in the mother who fed her little guy doughnuts pre-op because "y'all said he could have anything I could see through."

[pagandeva2000, LPN]

unfortunately, patients lying is a fact of nursing life. as mentioned earlier, they are not well versed on the specifics of why we need to know this information,but it can be explained. and, document the patient's response. i have seen situations where i have even asked very specific questions, explained why i needed to know and documented it, only to get a totally different version from the doctors later.

just the other day this almost occurred. we have a policy regarding gardasil that if the patient either cannot recall her last period, has had unprotected sex within that past month or if her period is more than 30 days late, we have to do a pregnancy test. only exceptions, or course are those taking depoprovera that are within their schedule. this 21 year old patient was not on depo, reported her period to be say 25 days ago. i asked her if she had unprotected sex since then, explained that it is important for us to know because i would have to do a pregnancy test. she said she had not been having sex. somehow, i didn't believe her and stated that there were not enough information gathered to know if this vaccine can harm a fetus, so, again is she sure? because once it is injected, there is no going back. suddenly, she faltered and said "well, maybe i do need a pregnancy test".

many patients are poor historians, also. like it was mentioned, anxiety takes hold and no matter how we try to be gentle, some people think they are being judged by their answers. also, there are those who will blatently lie just to get what they want done. i had one guy that (thank goodness) reported that after getting the flu shot, he gets tingling around his throat and mouth, then a rash. i told him i can't give it to him and he told me that this is the last time he would admit this to a nurse because he wanted his flu shot. well, i made sure that i documented in bright red what his allergies were to the flu shot. this man was going to purposefully deceive the next nurse because of his determination to get what he wanted. what if that were me?? and, if he goes to another place where he has no medical records, he will lie.

[chademack]

Shoot her, shoot her now! How dare she do such a thing...why she's only human. Shoot her!

Now... let's be serious. Understanding the situation is number one. Secondly, the Dr's have the responsibility of explaining the situation to the patient, period. And some people can have water, depending on the amount. See it all the time. Know thy situation and "Welcome to the big league kid..."

[roser13, ASN, RN]

Speaking of pregnancy tests and patient memory.....our facility policy used to be to allow a female of childbearing age to sign a waiver of pregnancy test. UNTIL the 37-year-old who actively lied to nursing and anesthesia and signed a waiver prior to her non-emergent lap chole. When the surgeon encountered a 5-month uterus, all involved were greatly affected. The anesthesiologist spent the night worrying about the anesthesia impact on the fetus. The admitting nurse did the same. The policy was changed. No female of childbearing age may sign a waiver now.

And the patient? We had to keep her overnight to allow her to regain legal competency in order to "inform" her of her condition. Meanwhile, we couldn't fully explain to her parents and teen children (HIPAA) exactly why she had to spend the night. After an OB/GYN was called in to counsel her, multiple explanations were given.....it was impossible, then she was molested, and finally, oh yeah, she'd slept with an old boyfriend 6 months ago.

Can you tell this is a hot topic with me?!

[chademack]

The hottest part of that topic is the stupidity of HIPAA. If ever their were forces that combine the ignorance and incompetence of the highest level it is the perosn or persons that think up such laws with no concept of what to do in special situations. That is why I hope some people get their asses sued off, cause they should and so should the idiots that allow a 14 year old patient confidentiality. If you want trust so baldly, adopt them. otherwise if you live under my roof....its my law. In Huntsville Alabama, a 16 year old boy told his Psych Doc that he wanted to kill his parents.... not until they and their other children were brutally murdered by their son did anyone find out due to patient confidentiality. Don't you dare read this and say that somone made a mistake or the law should have been involved.......cause its too late. would'a, could'a, should'a...crap. that is what the perversion of morality and ethics does for this country.

[angel337, MSN, RN]

i will educate patients until the cows come home but i refuse to make a patient do something that the clearly don't want to do. i have had to bluntly tell pts "ma'am/sir this is your life, your health, if you don't want to comply we can't make you" i document, document and its out of my hands. you will be surprised how after that statement they suddenly become mature adults instead of toddlers.

[JoblessRN]

And some people are just plain dumb.....as in the mother who fed her little guy doughnuts pre-op because "y'all said he could have anything I could see through."

ROFLMAO!!!!! :roll:roll

I am seriously beginning to think that some people should be required to have a license before breeding.

[JoblessRN]

She was married to a physician and didn't feel inclined to share any info with a lowly nurse. The anesthesiologist walked into the room (having been briefed by me beforehand) and the patient was all smiles and cooperation. quote]

OMG I hate that!!! That just **burns** my hide!!!! :angryfire:angryfire:angryfire