Bluff Indicators in Medical and Dental Tele-Consultation: A Review

ABSTRACT

The global lockdowns have resulted in the popularisation of tele-consultation. Also the anxiety about dental visits and hospital-acquired infections in patients and incidences of dishonesty are increased. Tele-consultation includes patient data collected on phone calls, text messages, and video calls. Bluffing or providing false information is one of the dark realities of clinical practice. Dishonesty might affect the treatment success and spread of contamination. During normal and epidemic eras, skills for honesty and bluff identification are required during tele-consultation to protect patients and doctors from hospital-acquired infection in further one-to-one treatment meetings.

INTRODUCTION

Lockdowns and telemedicine have been popular since the onset of the coronavirus pandemic. Furthermore, clinicians had been relying on phone calls, video calls, or texting prescriptions to their patients.[1]

According to one survey, 73% of patients lied to their dentists. The bluff list includes lies about their oral hygiene, brushing frequency, unhealthy diet habits, and sometimes systemic diseases or infections.[2]

People have a variety of concerns when thinking about scheduling a dental appointment.[3] Control, shame, cost, and trust are psychological and emotional elements that are crucial and, for many people, more anxiety-inducing than pain aversion.[3]

Dishonesty in case histories proved fatal to hundreds of doctors, or COVID warriors.[4] In a contagious pandemic like coronavirus, probabilities are that the patient is not showing symptoms at the time of treatment, but he might be in the incubation period, or he might be a carrier of the virus.[5,6] In fear of being caught and getting isolated, many people were dishonest at airports, taking paracetamol to suppress their symptoms of fever to escape thermal detectors.[5]

Misleading information or hiding the truth from dental physicians is a dark truth encountered in clinics, hospitals, and dental facilities.[7,8] According to research, there is a very low probability of humans having the tendency to detect a lie,[9] and honesty-revealing skills are necessary for the betterment of clinicians.

DISCUSSION

Honesty indicators in data acquired during telemedicine (Text, Audio/Voice, and Video)

Carefully visualization of data acquired during text messages/audio/video calls, photographs sent, and other symptoms[1] told to the dentist reveals much information about bluffing. The presence of swelling, mouth opening, and speech patterns of the patients give clues about the urgency of the visit to a clinic.[10] It can also be judged on the basis of the speech pattern in the case of audio calls, facial clues in video calls, and writing patterns in the text [Table 1].

Table 1.

Bluff indicators in dental tele-consultation

Tele-consultation mode	Deception of data in strategic conversation	Lie indicators
Text message	Writing pattern	Longer messages, Lesser use of self-pronunciation, No committable words, making stories, not to the point answers.
Audio call	Speech pattern	Variation in pitch (low pitches or whispering), a slip of the tongue, breathing alterations, Anger nodes, unclear sound
Video call	Facial expressions+Speech pattern	Blinking of eyes, sweating, lack of eye contact, guilt, head-scratching, and faking smiles + lie indicators of audio call

Honesty markers in text

Writing patterns in the text reveal about the buff. The text would be longer and less to the point answers. An untruth-worthy patient will avoid taking responsibility. There will be the least use of self-addressing words like I or we and the use of third-person words in abundance (he, you, your). There will be descriptions of possibilities and lack of commutability[11]

Honesty markers in voice/audio call deception

Speech patterns: A practitioner may get clues from the low or high pitch of the patient; a liar tends to whisper more or speak slowly.[9] A dishonest man tries to fabricate stories with slips of the tongue frequently when asked the same question repeatedly.[8] An untruth-worthy patient tends to give over explanations and information. Indirect speech can also be a clue to vague or untrue contexts.[12] Overpowering tone of voice and intense anger nodes and a high pitch indicate that a person is trying to make you believe his lie.[13] A patient would sound unclear and sometimes seem helpless or avoid conversation.[13] A dishonest man will be noticed to breathe more frequently or more slowly than usual.[8]

Sometimes, swallowing words is also seen in the context of lying in case histories.[14] A lot of people show no interest in your questions and overpower them with their chief complaints.[15]

They feel no relativity with your questions and tell, “everything is fine, I just have a toothache,” it is a great sign that they are trying to hide their true symptoms or systemic conditions they are suffering with.[13]

Video calls/clinical visit deception

Various lie indicators can be seen or should be looked for in the behavior, speech, and body language of the patients while interacting with patients from a safe social distance.[9] In this mode, the signs seen in photographs can be correlated.[9]

Behavior indicators

When someone lies, he fears being caught; this principle can be applied to check for some clues of stress,[9] which can be noted in his gaze, movements, behavior, and sitting-standing positions.[16]

Visual clues

A lie can be seen in someone’s eyes. An untruth-worthy person will avoid seeing in your eyes and tends to look here and there or may look at the floor with an essence of guilty feeling.[1]

Speech patterns

Recitation of lies includes lifting of shoulders, altered speech, and all the indicators mentioned in voice call deception.[9]

Facial patterns

A bluffer would blush or fake smiles; the patient would try to hide his fear behind his smile.[17] In answering, he or she would be found speechless with dilated pupils.[8] the scratching of the head and lack of head movements can be a clue of a lie.[14]

Some patients try to be teary or gloomy for no reason and insist you treat them without asking about their history.[12]

Also, another pattern of untrue speech consists of too much blinking of eyes, sweating, and inaccurate about the time period.[8]

Conversation strategy to catch a lie

Strategic interaction is the way to extract out the truth behind a story. A liar may be a master of story build-ups, but sometimes observers can have evidence against them about their story. If the dentist makes his interaction and inspection harder, it would be harder for the liar to escape and lie more.[9]

Research says that liars do not rely on what they say. They speak slowly, hesitating and making errors about date, time, and locations; they tend to struggle with grammatical errors, and if asked to say their story in reverse order, truth tells tend to add more details often and keep standing on their memories[18]

We can ask questions on the basis of our previous interactions. For example, if somebody says I want my treatment earlier, as I have to travel back, he might be a person working in affected areas. Further questioning should be based on the question of where he works and where he has to go. We may also ask about their boarding tickets or the date of traveling back.[14]

The previous behavior of the patient also provides information and adds accuracy to one’s lie detection in normal clinical setups. Most of the lying patients tend to overact about their illness, tend to hide the true symptoms of the infection and try to confuse it with other symptoms of the normal conditions.[16]

CONCLUSION

During general and pandemic eras, various psychological and emotional factors affect the honesty of the patients, detecting deception during tele-consultations is requiredl and plays an important role in a clinician’s decision-making and treatment success.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.