I'm an anesthesiologist, so events transpire MUCH faster than in the world of "clinic" medicine. In the OR, I had a heathy young man come in for an emergency procedure (one that is fairly common). He seemed like a good kid, smart, otherwise healthy. I asked about his drug history (standard question I ask EVERYONE) and he replied that he has never in his life had any alcohol or drugs of any kind. So, I'm not stupid, this question was asked in front of his very worried parents and most teens tend to lie about that sort of question. So, as I always do, I ask him that question again as we are wheeling him toward the OR, after his parents have left him. He (believingly) told me that he did not use alcohol or drugs. Okay.
The procedure is going fine and his anesthetic is going well. In response to some vital sign changes (increased blood pressure), I give him a very effective drug that I use for most patients. This is a very effective drug and works great.... usually. But, in this situation, it had a paradoxical effect.... it made is blood pressure shoot up, instead of decrease. Yikes! The only way that this could happen with this drug is if the kid has cocaine in his system. He really did seem like a straight shooter (and I am not easy to fool at this stage in my career). So I gave him some other drugs and attributed the increased BP to another common cause. Things stablized and were happy again. A bit later, his BP increased and I used the "first" drug again and got an even higher increased BP in response (which scared the crap out of me). At this point, I KNEW the kid had lied to me about not taking drugs and that he had (a fair amount) of cocaine active in his system. I gave him the appropriate drug for someone who is taking cocaine and everything was happy again. The rest of the anesthetic was uneventful.
In the recovery room -- his parents were not there -- I asked about the cocaine. After A LOT of prodding, he admitted to the cocaine use, and said that he was using daily. He didn't think it was a big deal to tell me. Yikes! This was a VERY smart kid and he didn't think it was important to be honest with his doctor. I told him that he could have died or had a stroke. I'm not sure he believed me. I decided that I would put admit him to the cardiac floor for overnight cardiac monitoring because of the BP spikes he got during the case. He would be the only teenager there amongst middle-aged/elderly cardiac patients. I told him why. He asked me to come up with a reason and tell his parents something other than the truth. I told him that he would have to tell his parents himself why he was on the cardiac floor after a routine and successful emergent surgery. I wouldn't and couldn't tell them the reason as that would violate his privacy.
I was right in my initial diagnosis, but allowed myself to become convinced by the smart/nice kid that I was wrong. Then, I was shown to be right shortly after. Damn, just one more instance of patients lying to me.