It's one thing to cough and sniffle in front of your parents when you don't want to go to school, but it's a completely different thing to fake it to an actual doctor. Man, that takes balls. What if the doctor sees right through you?
Doctors of Reddit were asked: "What do you do when you see a patient is obviously faking it?" These are some of the best answers.
1/16 Former paramedic. Fake seizure? "Oh my, it's too unsafe to move them like this. We'll have to put in a catheter first." And wouldn't you know it? A miracle.
2/16 Doctor here. Fakers are difficult to handle. Adult fakers are usually quite sad affairs, and there is really no satisfaction in exposing them.
One story is a young guy in my town who has a weird and unexplained addiction for getting a cast. Not having one, GETTING one. He has come in to different ERs claiming an injury, but there are never any objective finds. Then he usually gets a cast (since he is in pain, he gets one for pain relief), and then comes in multiple times because "he got his cast wet", "the cast hurts" and so on, and gets another one. He has done this so many times that he is now well known by most staff and doctors in the ER.
I met him once, and since I hadn't looked at his patient history beforehand, I believed him and sent him to the relevant examinations. And even if I did know his history, it would be wrong of me not to trust him, because this time the injury might just be real! It's more important for me to protect my ass, even if it means that some extra work is done for nothing (and in my country this guy doesn't pay the actual costs of having these x-rays and ultrasounds).
3/16 It's called the Jedi mind trick. When arriving on the scene of a car wreck look at all the standing victims and say "Everyone is alright, right?" This keeps the healthy from thinking hard about minor stuff.
4/16 Kid who refused to bear weight on his leg after a fall but otherwise wasn't complaining. Do two physical exams, a regular one (where they cry if you get close to it), and another one where you distract them. Sure enough when he was playing with bubbles he didn't notice me touching his leg.
5/16 Paramedic/flight paramedic. I'm one of the weird ones. Unless someone is obviously drug seeking, I tend to treat what the patient tells me, not my impression of their situation. I'm talking specifically about pain here. Our medical community has been trending towards demonizing narcotic pain control, and I think that's one of our biggest shortcomings. Adequate pain control improves so many things, patient compliance, recovery rates etc. If someone tells me they're in a lot of pain, I generally believe them and treat accordingly. Percocet, T3, Diluadid, Morphine, these are medicines people.
6/16 As a paramedic, I have been known to fake the faker.
I had a girl in my district that would fake seizures all the time. I'd usually put normal saline in a nebulizer and fog up the back of the ambulance while telling my partner that the anti-seizure mist was on and she should be all better soon. Funny how she woke right up every time.
7/16 I'm an EMS pilot and the nurses/medics have shown me a couple of awesome tricks they use on fakers. When they are sure a person is faking that they are unconscious they will lift the person's hand up over their head and let it go. The fakers won't let the hand flop down directly onto their face. If they're out for real, it'll go straight down. Another fun one to watch is when a person's faking a seizure, the nurse will announce loudly that they are going to start an IV on a specific arm. It's funny to watch somebody faking a seizure with 3 limbs moving instead of 4.
8/16 We get a lot of training for this in school for audiology. People fake hearing loss all the time to get worker's comp or money from the government for service-related hearing loss. Here's the thing: we can always tell. There are only a few specific ways that the way you hear through air conduction (when the sound has to go all the way through your outer and middle ears before reaching the cochlea) and bone conduction (when vibration of your skull sends the sound straight to your cochlea) can interact. People who are faking tend to pretend their hearing loss is flat across all the frequencies. If someone is pretending to have hearing loss on one side only there is even a special test called the Stenger that we can do. Basically you play sounds in both ears but the brain only perceives the louder sound, so as soon as the sound in the person's "bad" ear gets louder than the other ear, they stop responding.
We're trained not to ever let on that we know the person is faking. We blame it on the equipment, we move to a new sound booth, we tell the person that the test results just aren't matching up and we should have them come back another day. Basically you give the person every chance to tell the truth. If they never admit to the fact that they are faking, we can run a test that measures brainwaves in response to sound and prove their approximate thresholds that way. HOWEVER, some people have psychosomatic hearing loss, where they truly believe they cannot hear even though they physiologically can. In kids this can be caused by trauma or abuse, so even if we really think a kid is faking, we would never tell their parents that in case it meant additional abuse for the kid. There is a point at which we bring in social workers, psychologists, etc.
9/16 As a veterinarian, I don't have this problem. I HAVE seen my fair share of drug seeking owners, however, that will lie about their pets' clinical signs because they think I will prescribe something that they can take.
10/16 I'm a doctor but as a pathologist I don't have to deal with malingerers directly any more. I just get to do their autopsies and say, "Well, I guess they weren't faking this time."
11/16 Tell them the only solution is amputation
12/16 As a hearing doctor, we take whole classes at university in how to identify fakers, because hearing loss is one of the most common false claims for disability compensation, or kids who want attention / to get out of school. It makes sense that people would try, because even in legitimate cases there is usually no way to tell if anything is wrong just by examining the body; you have to rely on the responses the patient gives. But our techniques to detect liars have evolved right alongside their techniques for lying, and we pretty much have the upper hand at this point.
Especially for little kids, but it's been known to work for adults of less-than-exceptional intelligence: quietly whisper something like, "Do you want some ice cream when we're done?" 9/10 times, the guy who just denied hearing a 100 decibel tone will say "Yes, please."
And of course, the real kicker is we can sedate you, put some electrodes on your brainstem, and prove beyond the shadow of a doubt that your brain is picking up the sound, but that's expensive, and you're a poor clinician if you let a case get to that point. Playing them psychologically is much cheaper.
And what do we do if we actually find out you're faking it? I personally try to be compassionate about it, because even though I would never try to pull something like that, the motivation is obvious, and you sort of can't blame them for trying. A lot of people realize they're in over their heads halfway through, and they appreciate getting an excuse to change their behavior, like "Oh, these headphones must not be working; let me give you a different pair." Then they start responding.
But if they take it to the bitter end, I still can't prove they are faking intentionally - there are possible psychological or neurological reasons for "non-organic hearing loss" that are truly beyond a person's control, no malicious intent whatsoever. So I just present the results in a neutral, non-accusatory tone, as honestly as possible, "We could find nothing wrong with hearing system biologically, but you report that you still have a hearing loss, so the issue must be deep in your brain where we don't have the technology needed to detect abnormalities." Then I make the referrals to an auditory processing disorder clinic or a psychologist as necessary, call it a day. The mere suspicion that someone is trying to deceive you, no matter how strong, is never an excuse to be rude.
13/16 Not a doctor but once when I was a kid, my doctor knew I was faking sick to get out of school, so he told me he thinks there's a problem with my sex organs (I was faking the flu) and asked me to take my pants off. I immediately felt better.
14/16 I am a dentist, and unfortunately I get people who I think are faking pain for drugs all the time.
This is a huge generalization but for the most part, people who are only seeking pain meds tend to be of a lower income population. That being said, they almost ALWAYS elect to have a tooth extracted rather than restored because it is much less expensive.
It is often hard to get an infected tooth numb, so all I have to say is "Ok I would be happy to pull this tooth for you, but unfortunately I will not be able to get the tooth fully numb and you are likely to feel a lot of pain during the procedure."
Now, this is not really true, I can always get a tooth numb, it just takes a little longer sometimes. If the person is faking it, they are unlikely to go ahead with the procedure, but if they really are in that much pain to begin with, they will do anything to get the tooth to stop hurting. Anyone who has ever had a bad toothache will attest, it is one of the most painful experiences anyone can go through.
15/16 As a former faker of strep throat, they know. They always know.
16/16 Critical Care physician. Depends on the situation.
Fake blindness? Some recommend "confrontation", basically waving threatening objects close to the face. One ED doc I know even recommended going at them with a needle. This seems as if it could become self-fulfilling. More subtle approach: several signs with letters and pictures; ask if the patient can see each one. Last sign features something obscene about their mother. Watch for change in facial expression.
There's a whole body of literature about symptom validity tests. General idea: we can predict how a disease will act, and how it won't act. We know this better than the patient. If the patient has a disease, the disease will quickly teach him what he "should" be feeling and not feeling. If he's faking, it's tough to figure out the right set of symptoms on the fly.
Unfortunately, we as physicians don't really know that much and don't read too often and so we often don't know either. And then patients end up getting their drugs and going home, which is what everyone wanted in the first place anyway. Intellectual purity is not our strong point.
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