Between Omission, Deception, and Health: Understanding the Risks of Patient Nondisclosure on Clinical Outcomes

General
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Understanding the Risks of Patient Nondisclosure on Clinical Outcomes :stethoscope::speech_balloon:

Early in my clinical training, I observed patients often omitted medications or downplayed symptoms either deeming them unnecessary for junior doctors or minimizing minor issues. Only after referral to a senior physician did the full picture emerge. Fortunately, no harm occurred, but nondisclosure can significantly affect patient care.

This behaviour of the patients isnā€™t blameworthy. Most patients withholdā€‹:zipper_mouth_face: at least one medically relevant fact due to fear of judgment, misunderstanding, or personal biases, including information from internet searches :globe_with_meridians: (ref: PMC6324389, PMC6694393).

Even minor omissions like unreported medication interactions or overlooked lifestyle factors can lead to wrong treatment, repeated visits, or delayed referrals. Research shows these gaps increase risksā€‹:warning: and affect clinical outcomes. (ref: PubMed 30646397).

Solutions lie in communication, trust, and empathy. Structured approaches, such as Murtaghā€™s General Practice, the Oxford Clinical Handbook, and relevant workshops or training, guide clinicians in asking questions that uncover subtle details. Open ended prompts, like ā€œHave there been any small changes in your health?ā€, or gentle exploration of medications and habits, often reveal information patients might otherwise withhold. Patients benefit by being open, while clinicians benefit by listening actively and creating a safe space.

In medicine, the unsaid can be as important as the said. A little honesty goes a long way, and saves both time and forehead wrinkles for patients and doctors alike. :grinning_face_with_smiling_eyes::herb:

:pushpin: References and suggested approaches:

Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to CliniciansPMC6324389 JAMA Network Open (2018)

Assessment of Patient Non disclosures to Clinicians of Experiencing Imminent Threats. PMC6694393 JAMA Network Open (2019)ā 

Prevalence of and Factors Associated With Patient Nondisclosure of Medically Relevant Information to Clinicians PubMed 30646397ā 

Murtaghā€™s General Practice

Oxford handbook of clinical practice

When was the last time something left unsaid made all the difference in care? :magnifying_glass_tilted_right::thinking:

MBH/PS

3 Likes
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Only by creating awareness and educating the patients, such non-disclosure can be omitted from the doctor-patient relationship.

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Clear disclosure can help to improve outcome of treatment as well prevent unwanted complication

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Absolutely!

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True. If only we as a society worked together :grinning_face:

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Building trust and history taking ( which is an art) can avoid such scenarios.

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True. Consultation skills are is harder than history taking for most doctors.

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Yes! Trust is of utmost importance. Maintaining confidentiality is very vital to quality healthcare.

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Your article captures the delicate balance between patient honesty and clinician empathy beautifully.