Detecting the Pain Liar

Detecting the Liar – By Lynn Webster, M.D. – September 2018

According to Scientific American Mind, lying “is among the most sophisticated accomplishments of the human mind.”

It requires cognitive skills that children are not born with and must acquire. Our ability to lie seems to improve until we reach young adulthood, and then it levels off. Once we reach about age 45, our ability to lie declines.

Discerning the difference between truth and lies seems to be even more challenging than telling a lie.  

Polygraphs were invented in 1921 as a better way to interrogate suspected criminals and get at the truth, but the machines’ scientific validity has always been questioned.

It seems that neither people nor machines are especially good at knowing the difference between truth and falsehoods.

Doctors Can Be Tricked by Lying Patients

Beth Jung, EdD, MD, MPH and Marcus M. Reidenberg, MD point out in a Pain Medicine article titled “Physicians Being Deceived” that doctors, too, have difficulty determining when their patients are telling the truth and when they are not.

Jung and Reidenberg believe doctors who are uncertain about whether or not patients are telling the truth when controlled substances are involved may err on the side of withholding medication.

Unfortunately, some patients may try to trick their doctors into prescribing medication, because they want to use the medication for a nonmedical purpose.

Doctors who believe some of their patients are lying are less inclined to believe any of their patients.

Additionally, they are less likely to sympathize with their patients’ pain for which the medication is intended. That can make it more difficult for honest chronic pain patients to get the treatment they need.

It doesn’t make sense to say some patients lie when also stating they can’t determine whether a patient is lying or not. Then how do they know that some of the patients they see are lying?

It’s like that nonsensical statement “I always lie”, which would mean the statement itself would be a lie, which would mean I always tell the truth, in which case the statement is true, which would mean I always lie, and round and round it goes.

Jung and Reidenberg researched several high-profile cases in which doctors were prosecuted by the Drug Enforcement Administration (DEA) for prescribing opioids to non-cancer patients.

But these cases are only a tiny proportion of the patients and doctors, so most doctors would still be wrong to assume their patients are lying just because a DEA investigation with deliberate deception by trained professional liars was able to trick some doctors.

In some of these cases, doctors had prescribed opioids to undercover DEA investigators who claimed they needed medication for pain.

The DEA then alleged that these doctors should have known the investigators were lying about their pain.

In a Pain Medicine article, “Pain, Patients, and Prosecution: Who Is Deceiving Whom,” Stephen J. Ziegler, PhD, JD, Assistant Professor of Public & Environmental Affairs at Indiana University-Purdue University, argues that doctors are not obligated to guarantee their patients are telling the truth or they are using their medication properly.

I agree. This is the personal responsibility of the patient and out of the doctor’s control.

He writes, “…just because a physician is deceived, the deception by itself will not incur liability.”

Prescribing With a Legitimate Medical Purpose

Licensed physicians, Ziegler says, are legally allowed to dispense controlled substances for a legitimate medical purpose.

“In the event that a physician issues a prescription for a controlled substance that was the product of deception, that standing alone will not criminalize his or her action,” according to Ziegler.

To get a conviction, the government would have to prove that the doctor “knowingly and intentionally” dispensed a controlled substance to a person without a legitimate medical purpose.

Unfortunately, physicians may not be convinced that Ziegler is correct.

Furthermore, doctors who trust their patients are less likely to detect when their patients are being dishonest.

Doctors often feel that their potential failure to detect a liar may put them at higher risk for prosecution.

Because law enforcement officials believe they usually can tell when someone is faking, they expect doctors to be able to do the same.

American Journal of Law describes an attempt to determine if law enforcement officials were more effective than physicians in identifying whether people were faking their pain.

The results showed that law enforcement officials were not able to differentiate the true patients from the fakers any better than the doctors.

Doctors AND law enforcement had about a 54 percent chance of detecting the liars.

So how about sending some professional liars to go fool the DEA into thinking some doctors were knowingly prescribing opioids to patients who didn’t need them?