The Doctor/Patient Pinocchio relationship and the COVID-19 pandemic.

It is a long established fact that patients lie to their doctors. These untruths may range from minor omissions, probably due to not recognizing the import of that ‘little’ experience they are not reporting, to outright lies in response to direct questioning.

As a medical student, and later a house officer, there was nothing as annoying as having painstakingly clerked a patient, a more senior doctor would then come and take history from the patient, and the two histories sound like they belong to two different people.  However, with a little more time and practice taking history, one learns the many different ways of asking the same question or eliciting the required information. Now, this phenomenon is not unique to Nigeria, or even Africa, as this study shows. But while the consequences of not telling your doctor the truth have always been personal until now – affecting only the patient’s management or treatment outcome, the Corona virus has put a different spin on things.

The initial spread of the Corona virus in Nigeria was aided by a deliberate withholding of information by suspected patients with travel history from then virus hotspots. These were not illiterate people or people who didn’t know better. Some of the people involved ranked among the highest public office holders in the land, prompting the then Chief of Staff of the Federation to write a letter to the House of Assembly, requesting that all lawmakers with a history of travel, who had hitherto refused to subject themselves to screening measures be directed to do so immediately. Another high profile case was that of a former ambassador who returned to Nigeria following travels in countries with cases. His samples were taken by the NCDC on suspicion of COVID-19, and while awaiting his results, and in the middle of a lockdown in Abuja, he managed to find his way to Kano, passing through Kaduna, and meeting with lots of people. On arrival in Kano, he attended many social and religious gatherings that saw him mix with a lot of people, and when he eventually came down with symptoms, he presented at the neuropsychiatry hospital in Kano, where he failed to mention his travel history, or the fact that he was awaiting testing results. He was confirmed positive while still at the hospital, and soldiers were sent to cordon off the hospital. He had also clandestinely sought treatment in other hospitals on his way to Kano.

In Ilorin, the management of the University of Ilorin Teaching Hospital suspended a Professor and senior consultant of Infectious and non-infectious pulmonary disease, for withholding pertinent history about his relation whom he had brought to the hospital, thereby endangering the health workers. His relation, who had recently returned from the U.K. and had been in self-isolation on the advice of the Professor, was brought to UITH by the professor, where they either denied or did not volunteer this history of travel.  Instead, he was attended to at the Accident and Emergency, rather than in the Isolation unit. The attending care givers became suspicious of his symptoms which strongly resembled COVID-19 symptoms, but he subsequently passed away before being tested. His wife, who was tested following his demise, however tested positive. All health care workers who came in contact with him were instructed to go into self-isolation and commenced on chloroquine prophylaxis.

With all these cases of lies, cover ups, jailbreak-like escapes from isolation centers and even protests in isolation centres where the confirmed and suspected cases freely mixed crowds and rabble rousers, it is a wonder that Nigeria has not witnessed an explosion of cases of epic proportions. Well, we can’t really tell because there is no mass testing.

Conventional wisdom advices that you never lie to these three people: your doctor, your lawyer and your spiritual counselor (if you have one). Although, one might see why a patient may feel the need to lie, if the suspected disease condition is one that causes stigmatization, COVID-19 is not one such illness, and lying serves no purpose other than to endanger the lives of family and friends, and health workers, whom are in short supply in Nigeria. Now, more than ever, the repercussions of lying to your doctor are more far-reaching than you might imagine. When in doubt, tell the truth!

#StaySafe #COVID-19 #Pandemic #PublicHealth

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