Hikaru nods as if he understands perfectly, which probably doesn't help Akemi's impression of him one bit. He even seems amused by her assessment of him.

"Ah, then I should have just made it all up, right? Claimed to be something noble like a doctor who's terribly torn up about all the patients I couldn't save."

"It's not like anything from me is ever trustworthy anyway. You're right to doubt me. Though I don't know if I can trust anything you say, either, of course."
As if him being a doctor would have been remotely believable, given the lack of smarts he's shown... But that's probably the point.