I've been pondering this thread for a few days now and in an effort to remove any potential ego from the equation, let me suggest this:
Exact same situation, but when asked the patient says that he just can't remember what the ophthalmologist said was wrong with this eyes?
As you say, a clueless patient is a completely different animal than one which is willfully misleading or who witholds information. The clueless patient at least in theory wants to know what's up.
I pose this question because its not unheard of for patients to get a 2nd opinion from a doctor without telling the doctor that they already have an established diagnosis from another provider.
See, I won't play that game either. I've had the situation quite a few times over the years where patients come in requesting a second opinion on "something" but won't tell me what it is. I always tell them they gotta at least tell me what the deal is. The most common one in our industry is "another doctor said I need surgery for cataracts. Do I?" Well, there can be a whole range of reasons why someone would or would not recommend surgery and usually you need to know the reason WHY the other doctor said what they said, not just that they have a catarct.
Sometimes patients come in and say that they want me to check them out and see if I can find the same thing. Like it's a little game. I won't play. I need a complete history.
I guess it's true that once in a great while a patient will intentionally not say anything to see if I come up with the same things the other doctor did. Contrary to what the patient thinks, that's not helpful to their care but in that case there's not much I can do about it I guess.
I kind of get why a patient would not want to say something, thinking that I will be quick to just agree with the other doctor but these interactions have to be based on a mutual trust and understanding. If I AGREE with the other doctor, the patient will likely go to another doc until they find one who DISAGREES. In other words, they doctor shop until they get the opinion they wanted.
Going back to the cataract example, here's a common source of trouble as patients jump from doctor to doctor year to year for whatever reason.
Most 65 year olds have 20/20 vision but also have a certain level of cataract. Do I tell someone like that they have a cataract? It's not affecting their vision, but it technically IS a cataract. Now....here's the two possibilities that usually play themselves out:
If I say something:
"You've got a tiny cataract here. Nothing to worry about, just the joys of being 65."
"Oh my God?? Really? The last doctor never said anything!"
Now there's two possibilities right there in the patients mind:
1) The last doctor was an idiot
2) I'm making it up for some reason
Or if I DO NOT say anything:
"The last doctor said I had a cataract. Do I?"
"Well, technically yes, but it's not affecting your vision so don't worry about it."
The two scenarios there are:
1) You're an idiot because you missed it
2) The other doctor made it up
So it's a damned if you do, damned if you don't.
That was a longwinded posting. At the end of the day though, the moral of the story is this: I need a complete and thorough history. I can agree in some cases to not aggressively test or monitor things depending on the condition if they are seeing another doctor but I at least gotta know what's going on. If not, find another doctor.