Practice MattersProfessional Development

Why do people lie?

  • Don Esco sought skilled nursing care at a Placerville, California facility for Johnnie, his wife of nearly 61 years, when she was recuperating from a bout with pneumonia. She died 13 days later. Esco sued, alleging that the medical records lied about Johnnie’s treatment.
  • In Santa Monica, a nursing home was fined $2,500 by the state for falsifying a resident’s medical record, which claimed that the patient was given physical therapy 5 days a week. The catch? At least 28 of those sessions were documented by nurse assistants who were not at work on those days.
  • A supervisor at a Carmichael, California nursing home admitted under oath that she was ordered to alter the medical records of a 92-year-old patient, who died after developing massive, rotting bedsores at the facility.
  • State inspectors in California uncovered suspicious charting and treatment records for a 50-year-old man admitted to the facility for various conditions, including a bedsore. His doctor had ordered daily wound care. Among other findings, the state determined that a nurse who documented treating the man between Sept. 3 and Sept. 30, 2005, had not been at work 22 days that month. She also had been off work the day she supposedly documented the man’s admission.
  • A 74-year-old patient was prescribed a daily Exelon patch for 60 days to treat his dementia, but only 28 patches had been removed from his supply. The patches release medicine continuously for 24 hours and help dementia patients with memory, communication, and reasoning. Records showed that staff nurses initialed 60 patches being applied, as ordered by his physician. A licensed vocational nurse was “unable to explain” where nurses obtained the other 32 patches that supposedly were administered.

Most of us think of ourselves as good. Certainly our intentions are good, and most of us judge ourselves by our intentions. We judge other people according to the results of their actions, but rare indeed is the person who judges himself or herself by the outcomes of his own actions! The result of this unbalanced state of affairs is that we frequently judge others harshly, and rationalize the negative results of our own actions by appealing to the good intentions we know we had. This tendency to minimize bad outcomes is exacerbated by both time and distance.

This all too human tendency is intensified when the wrongdoing is a result of having caved in to pressures. Subtle pressures co-opt one incrementally over time: What was previously unacceptable becomes first necessary (I don’t have enough time…), then accepted (Everyone else is doing it…), and eventually expected practice (This is just the way things are around here…).

Yet, according to a recent survey of prospective employers, employee honesty is rated ninth in a field of ten. The number two characteristic is “someone who will do what I tell him or her to do.” While these two items are not necessarily incompatible, they certainly could be. In fact they almost surely will be when someone threatens a lawsuit, regulatory agents are surveying, or when management promulgates a bottom-line rule mentality.

When a bottom-line ethos is created, ethical concerns often are trivialized or forgotten altogether. It seems that giving people “good reasons” for lying significantly increases the likelihood of good people telling lies! But not all people will harm others, even for good reasons and under pressure. And they are to be treasured above all.

It’s a matter of trust. When a person lies, they have broken a bond—an unspoken agreement to treat others as we would like to be treated. Serious deception often makes it impossible for us to trust another person again. If the truth only comes out once it is forced, as is the situation with the cases at the start of this article, repair of trust is far less likely.

The world is fragile and its resources are finite. Human technology has made life easier but more dangerous…certainly so for liars who, today, are almost sure to be caught—if anyone looks, that is. Fines, lawsuits, and scores are minor matters when compared to the public trust. The real issue here is that these people and agencies have broken trust with patients and families, with themselves, and with the various groups who have accredited them. They have sullied their reputation, and that of all those members of the health professions who do not lie.

Leah Curtin is Executive Editor, Professional Outreach for American Nurse Today.

Selected references

Lundstrom M. Falsified patient records are untold story of California nursing home care. The Sacramento Bee. September 18, 2011. Available online: Accessed July 21, 2013.


  • At a recent LTC patient care conference, the RN supervisor told me my 85 year old father was ‘wandering’ and permission was sought to restrain him. Upon further enquiry, it was found he was going to the smoking area of the facility. So, he was not wandering, but following the facility rules. I did not give permission. That same night I was called and told he had ‘assaulted a guard and was put in full leather restraints. The nurses were lying to get their own way.

  • A study conducted by University of Massachusetts researcher Robert Feldman indicates that men lie statistically more often than women. Some sources estimate the daily lies for men to be between 3 to 8. Teenage girls tell the most lies which is attributed to peer pressure and expectations. Surely not all of these people are ‘bad.’ Most lies are harmless, but some really do damage — such as lying to surveyors

  • Former Surveyor
    August 17, 2013 5:55 am

    At one point, CMS was considering that identifying “lying” from facility staff during a survey should be considered “Immediate Jeopardy” in that the patients were at risk for immediate and serious harm from staff members who did not tell the truth about care being delivered (or not). So you do no favor to your “team” if you lie.

  • I recently lost an excellent position in management because I would not lie for my boss in several instances. Quasi-military arena ( VA ), where following orders appears to be paramount.

    Did it hurt me, yes. Do I feel good about myself and doing the right thing, you bet. There are not necessarily winners or losers. Sometimes both sides lose. This is the unpredictable nature of life.

  • If you lie because your boss requires it, you are still lying although s/he may consider you “a good team player” but you should be aware that you’re playing on a “bad” team. So that makes you….?

  • Truth Teller
    August 8, 2013 3:19 am

    Is lying the same thing as ‘covering up’? My supervisor, nationally known & well thought of, bullies the people under her. Every Fall she hires a new employee & treats her like Royalty. Then when August rolls around again, the current Royalty is ‘horrible’ and the Bullying starts. She’s been confronted recently but narcissism made her deaf. We all need our jobs. So no one is brave enough to talk to Admin or HR. How to end this?

  • If your boss requires you to lie (e.g. to surveyors), isn’t lying just part of being a good team player?

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