DR MAX PEMBERTON: Do you lie to your doctor about how much you drink?… this is the giveaway sign

Sitting opposite me, looking me dead in the eye, my patient swore blind that he had stopped drinking. Very convincing he was, too, as he detailed how he hadn’t touched a drop of alcohol in months.

The only problem was that his blood tests told a rather different story. His liver function was through the roof. When I gently pointed this out, he paused, before saying: ‘Well, maybe the odd glass of wine with dinner.’

After further probing, it transpired that the ‘odd glass’ was a bottle and a half. Every night.

I wasn’t shocked. Not because I’m cynical but because I know, from experience, that patients lie to their doctors all the time.

Research by online pharmacy MedExpress in 2024 revealed that 73 per cent of Britons said they had lied to medical professionals. 

It’s a staggering figure, especially once you consider that 45 per cent of those surveyed believed that their dishonesty had delayed their diagnosis or treatment. .

And it’s not just alcohol people lie about, although that’s certainly the big one.

People also mislead about taking their medication, how much they exercise (or rather, don’t), what they eat, whether they smoke and about their sex lives and sexual health.

Bowel habits are another topic people often gloss over. Although I don’t condone it, I understand why. These are personal, sometimes embarrassing subjects.

Nobody wants to confess that they haven’t been to the gym since 2019, that they’ve been skipping their blood pressure tablets or suffer frequent bouts of constipation.

The reality is that we doctors nearly always know, or at least have our suspicions that our patients are not being entirely honest. We are trained to pick up on inconsistencies.

If someone tells me they barely drink but their blood results suggest otherwise, that’s a red flag. If someone claims to be taking their medication religiously but their condition isn’t improving in the way it should, I have questions. 

I see diabetic patients who swear they never touch anything sweet, then their HbA1c blood test comes back revealing that can’t possibly be true.

Some then admit they only followed the diet in the week before the blood test, not realising that HbA1c measures the damage done to red blood cells by sugar over the previous three months. 

If a patient tells me they exercise regularly but they’re breathless walking from the waiting room to my consulting room, something doesn’t add up.

Sometimes it’s body language. A slight hesitation, a glance away, a vague answer where a specific one was needed. We are not interrogators, but years of clinical experience teach you to read people.

What concerns me far more than the lying itself, though, is why people do it and how damaging it can be.

I might attribute symptoms to one cause when the real culprit is something the patient hasn’t told me about. I might prescribe a medication that interacts badly with something they’re secretly taking, or fail to screen for a condition because I’ve been given false reassurances.

In the worst cases, a lie can delay a diagnosis.

So why do people do it? Fear of judgment is a big factor. Many patients assume their doctor will think less of them, lecture them or write them off if they admit to bad habits, especially if they’ve been warned about them in the past. I promise you, we won’t.

We genuinely do not have the time or inclination to judge. We’ve seen and heard it all before and very little surprises us.

There’s something deeper going on, too. As a psychiatrist, I recognise that much of this dishonesty is driven by denial, one of the most powerful and primitive defence mechanisms we have. 

Denial isn’t simply about deceiving your doctor, it’s about deceiving yourself, too. If you don’t say something out loud, if you avoid it altogether, then on some level it feels less real.

The obese patient who insists they eat healthily and never snack isn’t just lying to me, they’ve told themselves that story so many times they half believe it. The heavy drinker who says it’s ‘only a couple’ has re-framed reality to make it tolerable. This is entirely human and we all do versions of this in our daily lives.

But in a medical setting, it can be dangerous. Denial keeps people from confronting problems that need confronting. It delays treatment. It can, in extreme situations, even cost lives.

So, next time you see your doctor, I implore you to be honest. Not because lying is wrong but because your health will depend on it. We are on your side and we want to help. But we can only do that if we know what we’re actually dealing with.

The consulting room should be the one place where you don’t have to put on an act. So please take advantage of that and tell us the truth.

My fears for Bea and Eugenie

I can’t help feeling sorry for the Princesses Beatrice and Eugenie as the Epstein files continue to reveal the true extent of their parents’ appalling behaviour.

The sisters are said to be ‘aghast’ and ‘mortified’. Beyond the shock, there is the shame. And shame is one of the most corrosive emotions there is.

It is not the same as guilt. Guilt says ‘I did something bad’. Shame says ‘I am bad’. 

What makes this so psychologically cruel is that Beatrice and Eugenie have done nothing wrong, yet they are carrying the shame of their parents.

This is something I see regularly at work: Children absorbing a sense of disgrace that belongs to a parent. 

It can be damaging to identity and self-worth. 

But nobody should maintain a relationship purely because of a blood tie, especially if doing so causes real pain. Loyalty has its limits. 

Sometimes the bravest thing you can do is walk away.

Have we been failing to spot autism in girls? A landmark study suggests we have. 

By tracking 2.7million people born between 1985 and 2022, the Karolinska Institute in Sweden found that while boys were far more likely to be diagnosed with autism in childhood, girls caught up during adolescence. 

By the age of 20, the diagnostic rate between the sexes was almost equal. 

Girls tend to be better at ‘masking’, mimicking their peers in social situations to fit in, which can conceal the very traits clinicians look for. 

As a result, many girls and women are misdiagnosed with anxiety, depression or personality disorders. 

I have seen women in their 20s, 30s, sometimes older, finally getting an autism diagnosis after years of feeling that something was different about them. 

A new study analysing 19million cancer cases in nearly 200 countries has found that 38 per cent of cancers are attributable to 30 lifestyle factors. 

Smoking is the biggest preventable cause but infections, such as HPV, account for one in ten. 

Dr Max Prescribes… The Examined Life by Stephen Grosz 

This beautifully written book by psychoanalyst Stephen Grosz draws on his 25 years of clinical practice to explore the stories we tell ourselves and, crucially, the ones we hide from. 

Through short case studies, he reveals how self-deception shapes our lives in ways we rarely acknowledge. It’s very relevant to my main piece: the lies we tell our doctors are often the same lies we tell ourselves. This will make you consider your own blind spots.