I sometimes answer “each day better then the next”, no one seems to notice.

I’ve always interpreted that question to mean emotionally. Yes, clearly I’m physically injured, but I still have a positive outlook.

When I do hear people respond in the negative it tends to be an opening up about stress.

Is that just a reflex response though? I would expect people to be more deliberate in their interactions with medical professionals, but I can easily imagine hearing “How are you?” and my brain goes on autopilot.

These days I do a 'eh' and shrug when someone asks a random 'how are you'?

At the yearly colonoscopy I say "you can tell me after how I am".

That’s not really an example of cultural lying- that’s an example of a fixed answer to a fixed question.

When somebody sneezes and you say “bless you” you’re not expressing your belief in god, and you’re not lying about one either.