Doctors are trained to look for patterns.
Symptoms. Signs. Test results.
But there’s another pattern that’s less often talked about.
People don’t always tell the full story.
We are, after all, the heroes in our own story. We leave out the less flattering details, emphasise the good, and occasionally bend the truth – not out of malice, but because it’s how we want to be seen.
When patients are less than honest, it isn’t usually about deception.
More often, it’s something much more human.
“Nah mate, I’ve given up smoking,” is sometimes said with the faint smell of cigarette smoke still lingering.
“I only drink socially,” which, on gentle exploration, turns out to be most evenings.
These moments are familiar to most doctors. Not because patients are trying to mislead. But because the truth is often uncomfortable.
There are certain areas that keep coming up. Not because people are dishonest – but because these are the parts of life that feel most personal, or most open to judgement.
Alcohol — often underestimated
Smoking or vaping — minimised or denied
Recreational drugs — frequently not mentioned
Diet and exercise — described in broad, optimistic terms
Taking medication — where “close enough” feels good enough
Supplements — often not seen as relevant
Sexual health — sometimes avoided altogether
Mental health — glossed over as “I’m fine” or “she’ll be right”
These aren’t random omissions. They tend to include the things people feel least comfortable talking about.
Sometimes, it’s not about hiding anything. It’s about how people understand their own behaviour.
I once saw a patient with diabetes who was struggling to lose weight. She was doing all the right things – or so she thought. Eating less. Trying to manage her diet.
But she mentioned she was drinking eight glasses a day to help fill her stomach. It sounded familiar until we worked out that it wasn’t water she’d been drinking. It was lemonade.
She had assumed that because it was a clear, colourless drink it didn’t contain calories, “just like water and it tastes better”. It wasn’t deception. It was a misunderstanding.
The same applies to exercise. People often overestimate how much they’re doing – just as they underestimate what they’re consuming. Not because they’re being dishonest. But because it’s surprisingly difficult to measure ourselves accurately.
People edit what they say for all sorts of reasons.
Sometimes it’s embarrassment.
Sometimes fear of being judged.
Sometimes guilt — knowing what they’re doing isn’t helping their health, or not wanting to admit they haven’t followed earlier advice.
And sometimes, it’s simply not wanting to hear what might come next. There’s also that instinct to present the best version of ourselves when we want to be liked.
We all do it. The consulting room is no different.
Medicine relies on accurate information – not to judge, but to understand.
A missing detail can lead to the wrong diagnosis, the wrong treatment and unnecessary tests. Alarmingly, something important could be missed altogether.
Most doctors aren’t sitting there judging. They’re trying to make sense of what’s going on. And often, they know when something doesn’t quite add up. Not because they’re suspicious. But because experience teaches you what fits – and what doesn’t.
The most useful consultations aren’t the perfect ones. They’re the honest and even slightly messy ones. Where people say, “I probably haven’t been as good as I could be.”
That’s where medicine works best.
Instead of trying to present the “right” answer, it can help to think: “What would I want my doctor to know if they were trying to help me properly?” That usually leads to the truth that matters.
People don’t come to doctors to be judged. And doctors don’t expect perfection. Medicine works best when the conversation is honest – not because doctors need the truth, but because patients deserve the right care. You’re still the hero in your story. In this version, the doctor isn’t the villain – just someone trying to help you reach a better ending.
Dr Kathryn Fox is an Australian medical doctor and bestselling crime writer, best known for her forensic thrillers featuring pathologist Dr Anya Crichton. Drawing on her medical expertise, she crafts gripping, authentic crime fiction and is also a passionate advocate for forensic medicine education and public engagement. Her columns appear every Monday and Thursday.
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