|INTERVIEWING TIP OF THE MONTH
# 75 May 2006
"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.