Sarah Krüg, patient advocate, and Brian Smiga, founder TEDxAsburyPark, talk about the lies patients tell their doctors and how Krüg hopes to counter that with a new project she is working on.

Brian Smiga: Hi, this is Brian Smiga. TEDxAsburyPark. I’m here interviewing Sarah Krüg, one of our veteran TED speakers who’s coming back to our stage in the spring of 2021 when we hold TEDxAsburyPark in Red Bank at the Two River Theater on the theme of Joy. Welcome Sarah.

Sarah Krüg: Thank you Brian.

Brian Smiga: It’s great to have you here, and I know you’ve got a career and a calling in patient advocacy. Tell us about you and what led you to that journey?

Sarah Krüg: Sure. I’m a cancer researcher by trade. I’m a patient advocate by choice. I went into cancer research because I lost both of my parents to cancer. My work now is focused on amplifying the voice of the patient, the voice of the care support partner in the design of innovation and redesign of healthcare, and really focusing on bridging the gap in the patient-doctor relationship.

Brian Smiga: Wow, that’s such a great calling. You’ve developed a number of studies and practices around this and today we want to talk about patients sharing transparent information with their doctors and their caregivers. How did you come upon that idea?

Sarah Krüg: The project was inspired by a talk that I did called The Patient Doctor Tango, which was focused on the cornerstones of improving the patient-doctor relationship. I use the analogy of the tango to illustrate the give and take in the patient doctor relationship. During the talk I asked the audience, how many of you have asked Dr. Google a health question that you would never ask your doctor? How many of you have lied or withheld a few details during a visit with your doctor? I then confessed what I’d lied to my doctor about. About 50 people were lined up to talk to me afterwards. Not to talk about the patient doctor tango talk I just gave, but one by one they came up to confess with what they had also lied to their doctor about. That was the origin of the Health Confessions project.

Brian Smiga: What do you think made them willing to confess or be transparent with you?

Sarah Krüg: I think it was because I had confessed in front of 3,000 people what I had lied about.

Brian Smiga: Yeah.

Sarah Krüg: I made it a comfort level. It was just me and them in that conversation. I didn’t have pen and paper.

Brian Smiga: It kind of comes down to the basic exchange between people sharing stories or sharing truths about themselves, and they want to reciprocate. It’s almost a kind of currency..

Sarah Krüg: Absolutely.

Brian Smiga: I wonder if this then influences caregivers to do a quick confession about themselves before interviewing a patient or asking a patient questions. That might work. I don’t know.

Sarah Krüg: Well, relatability. So, if a clinician, a doctor, a nurse, potentially shares information about themselves, that makes that person a little bit more relatable, and it makes the patient potentially feel more comfortable sharing their deepest, darkest secrets.

Brian Smiga: Wow. I think after this talk, you went on to create a web survey, which we’re going to talk about in a minute. Even a phone booth where people could deposit their confessions. Tell us about one of those.

Sarah Krüg: That’s correct. To date I’ve collected over 4,000 anonymous confessions. What people are lying to their doctor about. What they’re omitting from the conversation. I collected that data using a few approaches. One was a survey. One was where I dressed up a makeshift London telephone booth as a health confessional, where people could go in and either type in their confession into an iPad or speak it, or write it down and put it into a box. As a researcher, I looked at the main trends and studied why people were lying about some of these key elements of their health story. Then what the ripple effect of those lies are.

Initially, I was working on a publication that might wind up in a research journal that the lay person might not have access to. I took a step back and recognized the need to get this information into the hands of the average person out there that is lying to their doctor. If I could educate them on what people are lying about, why they’re lying about it, and the potential consequences of those lies, it might empower people to make better decisions on what to share with their doctor. That’s the premise of the book I’m working on called Health Confessions.

Brian Smiga: Health Confessions, by Sarah Krüg, coming soon.

Sarah Krüg: Correct.

Brian Smiga: Great. Now this is going to go better if we, each of us, do a quick health confession. Do you want to go first, since you kicked it off?

Sarah Krüg: Something that I’ve lied to my doctor about?

Brian Smiga: Yeah.

Sarah Krüg: Well, so the confession that I admitted on stage was when I was asked if I’d ever been exposed to secondhand smoke. I mentioned that I lost both of my parents to cancer. I have a crazy family health history, but I’ve, knock on wood, been pretty healthy. When I was asked that question I said no. When in fact my dad used to smoke two packs a day. The reason I did that was because I wanted, in my medical record, I wanted to be, I wanted to seem invincible and that nothing was wrong with me. I felt like that might be a ding in my medical record. Pretty benign, but still in the grand scheme of things that might be helpful information for the doctor to be aware of.

Brian Smiga: Mine is totally parallel, and I always felt it was a matter of pride and seeming like a rational human being that I would never admit that there was a period in my life when I smoked. After smoking in college and shortly after, I became a runner, and then a bike racer. I felt like I had fixed it, right?

Sarah Krüg: Right.

Brian Smiga: It just didn’t fit my identity anymore. There were two factors. One is I wanted to seem like a rational athlete and secondly, I was afraid it would raise my insurance premiums.

Sarah Krüg: Exactly.

Brian Smiga: That’s why I wouldn’t tell the story.

Sarah Krüg: Absolutely. Absolutely.

Brian Smiga: I think in the end, and now that I’m older, I now admit that I smoked for a period of time. I put it on my health record. Maybe it’s because I have Medicare. Anyway, moving on. There’s got to be some wild stories you heard, and since they’re all anonymous, do you want to share – either what was the most common lie or omission, let’s call it, and what was the most unusual one?

Sarah Krüg: Let me think about that for a minute. There’s a whole spectrum of what people lie about. There are simple things, believe it or not, that people lie about like their age, their height, their weight. People tend to lie about their eating habits and how much they exercise. People also lie to their doctor about their sexual orientation, because they’re concerned that it’ll potentially impact their care. I’m trying to think of some of the crazy ones. Obviously a lot of people lie about mental health status.

I was surprised that people also lied about, this was actually, I guess somewhat disturbing, but a cause of an injury, which might be related to domestic abuse. But I would say that the most lies were probably around…I’m trying to find a politically correct way of saying this, but it’s what I call the three P’s. They lied around, the three P’s are known as peeing, pooing, and procreating. When it comes to something like blood in their stool, they lied about that because they were embarrassed. When it comes to the procreation aspect, people lie about their sexual history, their practices, encounters, things of that sort that might seem like risky behavior.

Brian Smiga: Okay.

Sarah Krüg: There’s a whole spectrum of what people have been lying about.

Brian Smiga: Peeing, pooing, and procreating. Did I get it right?

Sarah Krüg: Yes, you did.

Brian Smiga: That’s funny. I think Erin Maguire, who’s going to appear with you on April 30, so folks on the line we’re in COVID sheltering today. Sarah and I are obviously recording this from our homes, but TEDxAsburyPark’s going to host a series of a Salon Socials online. For a hundred lucky people, Sarah Krüg and comedian Erin Maguire are going to entertain you for about 20 minutes of TED Talks and comedy. Then we’re going to have a discussion about this very topic around healthcare transparency in the age of COVID. That will be on April 30 at seven o’clock online. [Note: The Salon Social time was changed to eight o’clock after this was recorded.] So if you’re in our subscription list, or look to the link below. Sarah, we have to wind down. This has been really fun talking to you. What else might people look into to learn more?

Sarah Krüg: I just launched an Instagram account @HealthConfessional, where you can take a peek at other people’s anonymous confessions and even confess yourself. So definitely take a look, and I look forward to engaging in a conversation on April 30 and answering any questions that many of you might have.

Brian Smiga: That was @HealthConfessional?

Sarah Krüg: @HealthConfessional.

Brian Smiga: All right. @HealthConfessional. I’m going to go, as a good Catholic school boy, I’m going to go to that confessional right now. Oh, by the way, dear audience, we’re going to be sending out a survey just for the TEDx AsburyPark audience. You could take that survey and be part of the discussion on April 30 with Sarah, Erin Maguire, me and others from the TED community. Thank you so much, Sarah. Great to talk to you today.

Sarah Krüg: Thank you for having me, Brian.

Join the conversation with TEDxAsburyPark Salon Socials (online)

Sarah Krüg and Erin Maguire talk about the Joy of Confessions: Thursday, April 30, 2020 at 8:00PM. Register now for free

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