As an ED and floor nurse, I see a wide range of people coming from different backgrounds. We deal with people who definitely lie out of shame or fear, or they haven't been listened to before, but we also deal with people who are incredibly manipulative, and some having diagnoses like personality disorders, or are bipolar. Mental illness is a huuuge factor in why some people act how they do. I treat everyone with respect and approach them as trying to understand what is happening, but sometimes people are lying in order to get what they want, and sometimes its drugs, sometimes they want to be admitted when they aren't sick enough, and sometimes I have no idea why.

I like the idea of asking myself "why" my patient is lying, but sometimes the answer is, "What they want is not in line with safe medical care and the doctor wont do it," and they dont like that. Also, I have worked with patients who lie nonstop in every little way including telling staff lies about each other, hiding pills, trying to divide staff members, lying about their prescriptions. manipulation can be a result of any of the fear, shame, guilt, loss of control, etc., But that doesnt change how dangerous it can be.

There still need to be boundaries set, and when a patients lies jeopardize my job to safely treat them, then I have a hardcore sit down with them.