When Denise Connell’s doctor asks her about drinking alcohol, she replies in a way that might sound familiar: She’s not entirely honest. She says that she drinks socially on weekends.

“I do drink socially on weekends,” the Dedham, Mass., resident says. “But I also drink socially during the week.” 

Most weeknights, she’ll have a glass of wine with dinner, and another in the evening. And on the weekends, she might open a bottle of wine in the afternoon and finish it by the end of the night. 

Christina Raup of North Smithfield, R.I., also downplays her alcohol use. 

“I drink with the express purpose of getting a buzz,” she says. “I can’t tell them that. I say I have a couple of drinks once in a while.” 

And as for her history of drug use?

“I outright say no,” she admits.

Why lie?

You might downplay or lie about your habits because you don’t want to be embarrassed or feel judged. In Connell’s case, she’s not just a patient. She worked as her doctor’s medical secretary for six years. 

“I don’t want her to think I’m an alcoholic,” she says. “I don’t want her to feel disappointed, or say I’ve got to stop.” 

It’s the same with Raup, who also says she doesn’t want to feel like her doctor is judging her. 

“When a doctor seems judgmental, they are inviting patients to lie.”
Donna Casey
physician in Dallas

It’s something doctors need to watch for in themselves. 

“When a doctor seems judgmental, they are inviting patients to lie,” says Donna Casey, M.D., an internal medicine physician on the medical staff at Texas Health Presbyterian Hospital Dallas. 

“I try to be open and understanding and let people talk,” she says. 

You might also be leery about sharing information because you don’t want it showing up in your medical record. 

Sterling Ransone Jr., M.D., a spokesman for the American Academy of Family Physicians who practices in Deltaville, Va., notes that security on medical records is very high. That said, doctors may have some leeway about what they enter into the system. 

“Depending on what it is, it can be a matter of discretion,” he says.

You might not be fooling anyone

Does your doctor know you’re lying? Maybe.

“I usually can tell,” says Ransone. “I’ve done this long enough that my BS meter is on.” 

Here’s what doctors watch for:

“I’ve done this long enough that my BS meter is on.”
Sterling Ransone Jr.
American Academy of Family Physicians
  • People who aren’t making eye contact, or who change the cadence of their speech and start adding fillers like “uh,” “yeah,” and “you know.” 
  • The smell of cigarettes, which smokers often don’t notice. A (nonsmoking) doctor is likely to pick up the scent on clothing or hair right away. 
  • Downplaying alcohol use, which is so common that doctors are trained to increase the amount they hear from patients—Casey says she was taught to quadruple the number. 
  • A high heart rate, which can signal the use of amphetamines or Adderall, commonly used for weight loss. “It’s a federal crime, but you can buy these drugs and have them delivered to your house. You wouldn’t believe how many people do it,” Casey says. 
  • Urine screens that show marijuana use. People often don’t admit to their doctors that they use marijuana, especially in states where it isn’t legal, 

Fibs and health risks

When doctors ask about drinking, smoking, and drug use they aren’t just hoping to launch into a lecture—they know that these habits are linked with health problems. 

“I want to help you live a long, quality life,” Casey says. Ransone agrees. “My goal from a doctor’s standpoint is for you to be as healthy as you can be,” he says.

Doctors also might be concerned about your mental or emotional health.

The health risks of alcohol, smoking, and drug use are well known. Excessive drinking can lead to high blood pressure, liver and kidney damage, and increased cancer risk.

Smoking cigarettes is linked with high blood pressure, asthma, flu, bronchitis, COPD, and lung cancer. Smoking marijuana can lead to bronchitis and lung damage. People with a history of IV drug use are at higher risk for hepatitis C. 

And mixing alcohol or drugs with other medications can also cause problems. Combining alcohol or marijuana use with drugs like Benadryl or some prescription medications for urinary incontinence can trigger a high risk for falls. Drinking alcohol while you’re taking antidepressants can increase your risk of blacking out.

Doctors might also be concerned about your mental or emotional health. Are you drinking as a coping mechanism? Have a few cigarettes before bed because you need a break? These habits can fill a need.

“People don’t want to tell me these things,” Casey says. “They are embarrassed.”

Coming clean

If you’ve been fudging the facts with your doctor but overall you’re happy with your care, you might want to fess up. 

“I recommend honesty,” Ransone says. “You can say something like, ‘Last time we talked, I said I have one drink at night, but honestly, it’s probably two or three.’”

“Some people are going to drink or smoke no matter what, even if it cuts their life short. I appreciate their honesty.”
Donna Casey
physician in Dallas

If people are honest, she says, “I can help them get rid of the substance or manage their lifestyle so they aren’t at increased risk.”

A good doctor will work with you to help you stay as healthy as possible regardless of your choices.

“Some people are going to drink or smoke no matter what, even if it cuts their life short. I appreciate their honesty,” Casey says. 

In those cases, she might recommend more frequent x-rays or liver enzyme tests to watch for signs of trouble. 

And if you don’t feel comfortable being honest with your doctor, it might be time to make a change. 

“If you’re worried about telling your doctor,” Ransone says. “I wonder if you should find a new doctor.”