The detection of deception

In clinical situations patient honesty and self-interest usually coincide; however, in legal circumstances patients may be motivated to deceive and may be skilled in doing so. Research raises doubts about the capacity of health professionals to detect malingering, particularly when there is less known about conditions or expected symptom patterns, more definitive tests are lacking or require patient cooperation, and diagnosis depends substantially on patient self-report. Given the lack of systematic feedback about our judgmental accuracy when deciding the presence or absence of malingering, clinical experience per se provides an inadequate means for identifying and correcting erroneous practices and for determining just how confident we ought to be in our subjective impressions. Thus, in the appraisal of malingering, it is dangerous to place too much dependence on subjective confidence. Methods are discussed that can supplement medical examination and increase the accuracy of malingering detection.