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My best friend from medical school continues to wonder how the heck can I do the job I do, to wit, how do I listen to people’s stories all day long and figure out whether or not they are lying.  Actually, all doctors have this challenge. One hears subjective data, and tries to turn it into something objective.

For 20 years I’ve heard people’s self-perceptions of their memories and experiences. How ‘truthful’ is any of it?  This is especially challenging when it comes to recalling a traumatic event.  Was it really ‘how I remember it’ or was the ‘truth’ different?

Examples I have experienced :

A patient with a long time issue of rage at his father for not doing something in his youth, only to learn father actually did it.

A patient recalling being sexually molested by a doctor. It haunted her all her adult life. Later, upon confrontation with her mother, she learnes she had several urinary surgeries as a tot, and what she was probably  remembering was the traumatic/painful surgeries, insertion of tubes etc. and not sexual molestation. ‘I was always there dear, you were never left alone”.

A sibling pair, brother and sister, who recall their parents in very different ways – one recalls them punitive and unjust; the other has nothing but warm memories.  Is either right/wrong? Can both be right? Why do they not see/recall the other’s experiences?

I remember one patient long ago who was certain she was molested as a girl, but no one in her family who recalls this. She is vexed; is her memory ‘false’, or are the family members all covering it up?  She has no peace by their assurances and mutual agreement.

A married couple, I met both a few hours apart. They gave narratives of how horrible and crazed is the other, with little or no problems of their own. I am left with the questions: who is ‘right’?   Is someone lying?  What is really going on here?

This is called the “Rashomon” phenomena. If you haven’t seen the film“Rashomon” I very much recommend it. It is a story of a group of men who wait out a rainstorm by telling about a local. A bandit attacked a couple in the woods. The woman was raped; the man murdered.  The first man tells the story from the confession of the bandit. The 2nd heard the testimony of the woman. Through a medium, the 3rd heard the dead man’s testimony. Finally, the 4th man saw it himself, although he has reasons not to ‘tell all’. They (and we) are left with the aggravation of what the hell really happened and is anyone really ‘right’?  Is there such a thing as objective truth?  And is the subjective truth enough?

How do you find truth among subjective reports – and does it really matter?

In general, doctors are not trained in detective work. They are trained to make a diagnosis on what is presented to them. While instinct is useful, it is not very specific at discovering truth. As a lot, they are not very good at uncovering malingering or factitious disorders.

I work in a subjective world. I used to worry about missing things or having patients cover up/hide things or even lie to me. Happily, most of the time ‘truth comes out’. I merely have to wait and see.

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October 2011

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