Eliciting patients' lifestyle habits can be difficult

A physician reader of AFP submitted the following post.

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It is an unwritten law of medicine that patients tend to be less than entirely forthcoming when responding to queries regarding their intake of alcohol. I would guess that most physicians double or triple the number of alcoholic beverages patients admit to drinking daily. Similarly, when counseling patients with diabetes or obesity, I generally hear what I take to be gross underestimates of the amount of carbohydrates and total calories consumed. An individual might state with complete confidence (and often, indignation), "I eat almost nothing." He then might list his total food consumption for the previous day as "nothing for breakfast, an apple for lunch, a piece of chicken and a salad for dinner; that’s it."

I suspect that we all have an unintentional, perhaps uncontrollable, drive to appear better than we are in the presence of health professionals; we want to pass the test, so to speak. As a result, it is quite difficult to obtain accurate information regarding lifestyle habits such as diet, amount of exercise, tobacco use, substance abuse, sexual activity, etc. I congratulate patients who "come clean" and provide me with true descriptions of their daily habits. When asking them to keep food diaries, I explain that I am not grading them but, rather, collecting information about unhealthy aspects of their diet so that I can help them make adjustments.

Sometimes this approach works; often, it does not. After hearing another improbable tale of conscientious eating habits in a patient whose physical examination and laboratory tests suggest otherwise, I generally explain, “the laws of thermodynamics cannot be broken."

Bob Schwartz, MD
Chester Family Medicine
Chester, Vermont