Paltering: When the truth is used to deceive

Paltering: When the truth is used to deceive – by Shannon Casey, PA-C July 2019

One evening in the clinic’s bullpen provider office, a colleague of mine wondered aloud how to respond to a difficult question a patient asked via patient portal message.

A physician within earshot responded, “Just because someone asks you a question doesn’t mean you have to answer that question.” I tried to empathize with where the physician was coming from.

Some actions don’t require empathy as much as correction. 

Even so, the physician’s response seemed like a red flag to me, clashing with my own sense of personal integrity. Is it ever ethical to intentionally avoid answering a patient’s honest question?

During face-to-face conversations, I can see how it is occasionally appropriate to redirect a conversation for the sake of preserving the rapport that has been built during that patient-provider interaction.

in the clinic that evening, the physician wasn’t advising our colleague to sidestep a patient’s question in the context of an in-person encounter; rather, the physician was conveying that it was OK to dodge a patient’s question altogether.

I realized that the physician was an expert at a particular communication tactic known as “paltering.”

According to Todd Rogers, a behavioral scientist at Harvard Kennedy School, paltering is “the active use of truthful statements to convey a misleading impression.” In short, paltering is deception, yet he and his colleagues found that “the person doing the paltering believed it was more ethical than lying outright.”

Unfortunately, it is difficult for people to recognize paltering in real-time, which is one factor that makes it such an effective communication tool.

I’ve noticed that most of the “effective communication” is used for a doctor to defend himself against a patient.

Conveniently, paltering enables those who employ this tactic to easily justify their behavior. If challenged, they can claim, “I told the truth. I wasn’t lying!” and technically, this is accurate.

However, despite the absence of lying, the reality is that those on the other side of the conversation are still intentionally misled.

The same research shows that in fact, “The individuals who had been deceived […] did not distinguish between lying and paltering.”

Paltering is common and not necessarily malicious.

However, in the context of health care, we must always be vigilant about the ethical ramifications of such behavior. Is it ever OK to deceive patients or to condone this deception? If so, in what circumstances?

Paltering usually goes unrecognized and unchallenged, but when it is identified, it

  • erodes trust,
  • destroys confidence, and
  • contributes to cynicism

This is exactly what’s happened in pain management. Doctors believe and tell us that our pain “isn’t that bad” because it’s not an open wound or cancer or broken bone.

Doctors are being taught that non-opioid drugs and psychological therapy are as effective as opioids and they seem to believe it and insist that pain patients believe it too. Yet they don’t ask the obvious question: then why are non-opioid drugs and psychotherapy used only for invisible pain and not for visible pain, like in horrible accidents, shingles, cancer, or invasive surgery?

Isn’t being honest, in the truest sense of the word, the only ethical and acceptable way to practice medicine?

Shannon Casey is a physician assistant.

9 thoughts on “Paltering: When the truth is used to deceive

  1. GZB

    This one hits right on the mark. If a Doctor really thinks that lying would ever preserve a good relationship with me, he is only lying to himself. I don’t think I will ever be able to fully trust a doctor again after this facade of doing something for “my own good”.

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  2. Flutterby

    Even when there are multiple open wounds, like ulcerative impetigo (which ended up being caused by MRSA, as I told the triage nurse, the ER nurse, and the ER doctor was a distinct possibility), the increased pain I was experiencing was irrelevant. Once the nurse saw the fentanyl patch on my arm though… She got this look on her face that screamed, “Oh for Christ’s sake, she’s just trying to score more pain meds.” They even REFUSED to do BLOODWORK!

    The following day I was able to make it up to the lab at my doctor’s office (same hospital affiliation). The next day, I received a call from the very worried doctor that was covering for my own, asking if I wanted to be seen. Since I had seen him the previous day, I didn’t think I needed to be seen, and asked why she sounded so worried.

    My kidney and liver values were in the toilet. Thankfully, we tried a different antibiotic than the one I was taking – the one the ER assured me was the correct one for my condition. Had the ER bothered to do bloodwork, they would have seen that I had septicemia and should have been hospitalized. But I was already taking pain meds, so I wasn’t worthy.

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    1. Zyp Czyk Post author

      That’s truly a horrible story – they’d let you die just because you’re taking pain meds. There will eventually be repercussions for such doctors, but I wouldn’t hold my breath…

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  3. Kathy C

    That is a great word, it describes so many things. I had a visit with a neurosurgeon a while back. He was the only one that would take my insurance. I have to send my imaging before they would even see me. Unfortunately it was the same surgical facility that did a C Spine implant back on 2007. I had hoped that since the corporation changed hands they might be able to evaluate my condition objectively.

    The neurosurgeon acted as if I had no imaging, and treated me as if I had only recently noticed “back pain” he was clearly lying or paltering. They have imaging in my file going back 20 years and 2 surgeries and multiple interventions at their pain clinic. the doctor refused to meet my eye, and curtly recommended a chiropractor. He was abrupt and clearly wanted me out of there immediately. He would not respond to a question about whether having a spinal implant and having a chiropractic adjustment could be dangerous. He curtly responded that it might work, as if that meant anything.

    It took more than six months to even get the appointment after multiple referrals and a series of imaging and MRIs. The only other surgical facility told me that they could not see me,because I had the wrong insurance. The one that did was clearly Gas Lighting me, since they were replacing the failed implants in other patients. I know people who had to return and have rods removed from their spines, they were careful not to publicize any of this. Their surgeons had taken kick backs from the implant industry to buy these implants in the ER, while they were operating. Very little of that was made public, our local media did not cover any of this blatant corruption.

    We are living in the age of lies and Gas Lighting. In the doctor patients type relationship it is very frustrating to deal with this. I felt fear in calling the lies out. They very clearly knew how to steamroll over a patient like me,and I felt in physical danger. I knew that if I raised my voice, or reacted in any way, security would have dragged me out. The news about the FDA hiding the device reports, came out after this visit, which my insurance paid almost 500 dollars for. The corporation that ran that surgical practice, clearly trained these surgeons to Gas Light, Lie and mislead patients. They had the nerve to send me a patients satisfaction survey. Of course there was no box to check, for any of what I experienced.

    They had to cover up these botched surgeries where surgeons took money from device company reps, and Gas Lighting patients with failed medical implants is just doing business. They also cash in in on the multiple surgeries to remove the devices. It was really clever how they misreported all of this, and portrayed people with chronic pain from the devices, as psychologically unstable or drug addicted. I consider myself lucky they did not kill me.

    A friends mother went in for a routine surgery, and they sent her home brain damaged, without telling he family that she had a brain bleed. They rushed her to a hospital 60 miles away, where she died. Of course her death was unreported for the Medicare rankings, they cleverly released her to die at home, with misdiagnosed brain bleed. The system is so corrupt and damaged, nearly every local family has a horror story like that.

    The local news does not cover any of this anymore, they make millions on advertising for this non profit hospital. A lot of that advertising is In content marketing, and articles that appear to be news, but are really public relations releases. I noticed a number of new articles about wonderful people who run the hospital, or how much they gave to local charities. To maintain their non profit status, they have to give away some money to local clinics. This buys their silence too. When there are complications from these surgeries, people end up in these clinics, where they will Gas Light the patient too. Lying is really profitable!

    The FDA covered for the device manufacturers, even though they were caught bribing physicians. The cleverly used the so called opioid epidemic to deny care to these patients or follow up on the failed devices. Some of the recipients of these devices drank themselves to death, and it is possible this led to suicides also. Since the most common adverse event from these spinal implants was pain, even a few neurological side effects could be explained away. Patients that reported problems with these medical devices, could be labeled, and denied care. The device industry even paid researchers to “study” if these device failures were due to mindset or the patients attitude.

    They failed to put Gas Lighting and Paltering from your surgeon on this list. I did check the surgeon for a tremor and smelled his breath for alcohol, unfortunately the money he took from the device manufacturer was a secret.

    https://khn.org/news/fda-ends-months-long-foia-battle-over-medical-device-failures-says-putting-database-online-satisfies-khn-request/

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      1. Flutterby

        It certainly isn’t working now. For the routine things, yes, but anything involving pain is swept under the rug. A friend of mine has two stims – I’ve at the base of the spine and one in his neck. The leads in the neck migrated and caused jaw pain and it took him 2 months to get the surgeon to fix it! Well, fix it he did… with the WRONG LEADS! *sigh* We may as well have high schoolers doing the surgeries now; at least they already know everything?

        Liked by 1 person

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        1. Zyp Czyk Post author

          It’s truly horrifying how doctors are treating patients without providing pain relief anymore. The stories I hear of are getting more and more absurd and farther and farther away from the practice of medicine. It’s like we’re living in medieval times when there was no effective pain relief and superstition ruled medical practice.

          I’m incredibly lucky that my pain doctor has kept treating me the same. The only reason I had to taper myself was that CVS would no longer fill more than 90MME.

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