Culling the Truth in Disability Evaluations

Mar 07, 2017

“The capacity to create and recreate worlds and parts of worlds is imagination. It is through imagination that we can flee. But it is also by imagination that we can go in search.”

Leston Havens, M.D.
Pioneering psychiatrist

Culling the Truth in Disability Evaluations

TISA Description of the Problem: One of the most difficult arenas for uncovering the truth is during disability interviews. Sometimes patients, who truly deserve disability, are so frightened of not getting it that they over-exaggerate their symptoms, voicing what they think will get them the “okay” from the government. Bonnie Ramsey, M.D., who also provided our February 2005 Tip of the Month, has a very insightful way of navigating this situation.

Tip: For the patient who was trying to maximize their symptoms for disability during the mental status – and for whom it was clear prior to my mental status that they were functioning at a higher level – I find the following statement useful:

“In talking with you so far, I know that you have a real and serious problem. And I want to make sure that in my report your pain is adequately described, but if I write down all the answers you are giving me, they will know that you are lying. That won’t go over well. So, let’s try this again, and when I ask you the questions this time just tell me truth, so that I can help you to get the help you need. Okay?”

I have found this direct approach to be very helpful, and many patients then respond truthfully, and our rapport is improved.

TISA Follow-up: What a nice tip! A little truthfulness and direct communication from the interviewer results in more truthfulness and direct communication from the patient. I believe that a variant of this technique could be used with the patient in which you are not quite sure whether malingering is occurring or not. I would modify it, in these situations, as follows:

“In talking with you so far, it is not clear to me whether you have a serious problem or not, you truly might, I just don’t know. But what is clear to me is that you so much want to get disability that your answers are exaggerated. And I can pretty well guarantee that if I write your answers down, you aren’t going to get disability, because they will know that you are lying. That won’t go over well. So, let’s try this again, and when I ask you the questions this time just tell me truth, so that I can get a better idea if you can get the disability or not. I can’t guarantee you that you will, but I can pretty well guarantee you, that with the exaggerated answers, you won’t. Let’s go over these questions again, more carefully, and just tell me the truth, okay?”

Tip provided by:

Bonnie J. Ramsey, M.D.