Doctors are remarkably busy people. Now imagine just how many of them see patients who waste their time by faking illnesses.
Today's burning question came from Redditor kblimey2, who asked the online community: "Doctors of reddit, how often do you know that a patient is faking an illness?"
Some of these are infuriating.
"One of the stronger narcotic pain meds..."
One of the stronger narcotic pain meds we have is called "Dilaudid".
People love that sh*t.
Sickle cell patients usually know exactly what works for them, and also have a known history at the hospital. When they come in we just ask what they need and give it to them, we know them, we trust them.
One day this random John Doe comes in listing textbook sickle cell symptoms without much detail (red flag). He's got no record in the hospital (red flag). He's got "allergies" (red flag). He says:
"I'm allergic to Tylenol, Motrin, aspirin, morphine, lidocaine, capsaicin, ketorlac, fentanyl patch, Aleve. I can't remember what they gave me last time, it was the only thing that worked. It started with a "D" and rhymed with "bilaudid"".
Bruh, get out of my ED.
"I worked inpatient Neuro..."
I worked inpatient Neuro and this lady called like 3 of her outpatient providers saying she needed a refill on her prescribed benzos AND narcotics because, and I quote, she "flushed them down the toilet because she was going to the hospital and didn't want anyone to steal them," except that makes zero sense and, also, YOU'RE IN THE HOSPITAL. We literally have your med list and give them to you while you're there. It's not a hotel or something. You don't need to bring your own stuff.
Obviously she was livid when nobody would fill her script 2.5 weeks early and said we were trying to torture her. She also s*it on the floor in protest several times and even once in her only pair of PJs from home. She was very unpleasant. We have a huge drug issue around my area so we see this stuff often.
"The look on her face..."
Had a patient fake having a stroke. Even received the clotbuster drug, went through all the CTs and MRIs, the whole shebang. Faked the one-sided weakness, severe speech and language deficits. Didn't help that her speech/language errors were grossly inconsistent. And that she kept forgetting which side was supposed to be her weaker side when working with PT/OT. Or that she was caught Googling aphasia symptoms on her phone (despite being completely unable to read simple words at eval.) She was trying to get on disability. And wouldn't you know it, as soon as she was told workman's comp won't pay and that she would not be able to drive for an indefinite amount of time (after just having such a severe stroke, after all) the next day her speech and language symptoms were completely resolved. A goddamn Christmas miracle in July.
A couple years later, I see a woman for the exact same thing. Literally talking on the phone, chatting it up with family present but as soon as I come in her language falls apart. Even the elderly mother comments "It's so strange how she was just talking to us just fine but you have her try to read or say a couple words aloud and it's impossible! Why is that?"
"...I'll be right back."
I check her chart and pull up old notes. My old notes. It's the same woman as before. I tell the physician about her faking and he's on the same page as me.
The best part was walking back into the room and having her ask "so when can I get outta here and start driving again?"
"Oh dear, no!" I wave the wasted time of a fake evaluation I just had to complete with her. "From the deficits I saw on your eval, as well as PT/OT documenting fluctuating vision issues, there's no way any doctor will let you on the road for quite a while without some rehab prior!"
The look on her face when I said that made it almost worth all the time I had to waste on her jerking me around with her malingering.
I'm sure symptoms magically resolved the next day.
"I'm a paramedic."
I'm a paramedic. It's pretty easy to tell, but you always treat them by the book anyways just in case you're wrong.
Some people fake unconsciousness for attention, you can sternal rub them and pinch the nail bed with no response. I'll squirt a bit of saline at their face without warning to see if they flinch, or hold their hand above their face and let go to watch it magically fall to the side.
Those people still get full vitals, cardiac monitor, and glucose check though.
"Probably what I've seen most often..."
Less often than you'd think. IMO, we doctors think we're a better judge of character than we really are.
Probably what I've seen most often as a family med resident in a heavily opioid-laden community is complaints about chronic pain, and they're often very tough to deal with, because many are real and many are not. Patients are often insulted by the fact they have to give urine drug tests and sign contracts, but I've been burned several times. I had a new patient recently come in for chronic lower back pain asking to continue his existing Rx for Oxycodone 30mg 3 times a day, and that's a TON of opioid. I was able to see that he filled a weird number of these tabs (99?) in another state just a week ago. Called the pharmacy and they told me the doc who wrote the Rx is a suspected cash doc selling scripts for money and under investigation. I pressed the issue and he started crying, admitted that he's been selling pills to get by after he lost his job. Felt bad for him but obviously I can't do anything about it. His story is unfortunately common.
If you're looking for "funny" stories, I've seen a significant amount of what we call "psychogenic non-epileptic seizures" (or, hilariously, PNES), aka pseudoseizures. Not saying these are always people actively faking seizures - in fact, they can be a symptom of serious psychiatric issues - but it's also a great way to get benzos or feed a histrionic personality. Here's some of my favorite "seizures" I've witnessed:
Old woman literally putting her hand on her forehead and fainting dramatically into her husband's arms, and then saying "Whew that was a bad one!"
Young girl resting in bed, then saying "I feel one coming on!" and then closing her eyes and running in place, curiously aborted by flushing her IV with saline (salt water).
Another young girl falling down and straight up humping the ground immediately after informing me that the only thing that keeps her seizures away is Valium.
Middle-aged woman with "arm jerking seizures" that are only treated by IV dilaudid.
Young man resting in bed and then just screams his head off for 5 minutes while bouncing up and down in bed, also immediately aborted when he thwacked his head on the bed rail and had to get stitched up.
"I have so many of these!"Giphy
I have so many of these!!
--Male patient, 18 years old, rolled in unconscious. Mom says he's been like that for the past four hours. Go to check his lungs when I hear something interesting. I place the stethoscope near his mouth and hear him breathe in normally, but then breathe out by saying 'breath'. No joke.
--Male patient, 21 years old, admitted with inability to speak for last two hours and respiratory distress. Lungs clear, but we hook him up to oxygen for a few minutes. After he's taken off, his father comes running and drags me over, saying his sons tongue refuses to go back in after receiving the oxygen. I look at the kid and he's seriously just lying there with his tongue poking out like a child. I tell them to push it back in. A few hours later the dad tells me the boy is convulsing. I go to see without making my presence known and he's lying there just fine. The moment I ask the mom how he's doing, he starts 'convulsing'. Think of an odd version of the worm, but on his back.
--Female patient, 16 years old, admitted with complaints of recurrent seizures and frothing from the mouth. I look at her and she is literally blowing spit bubbles. I check her reflexes, everything is intact. The moment I turn away to check on another patient, she suddenly becomes 'rigid' and the spitting intensifies.
--Male patient, 30 years old, unconscious and completely unresponsive for six hours. This guy was totally dedicated to his act. I initially approached it as a stroke, but when the blood pressure, ECG, reflexes, pupils, etc all are normal....I start checking pain sensation. He slowly began to open his eyes and groan as I asked him to tell me his name, but the moment his Achilles' tendon was pressed, he suddenly sat up, stated his name, and declared himself cured.
--Female patient, 17 years old, complained of respiratory distress and convulsions. Everything's normal on admission, and she's conscious but refuses to eat. Parents are worried out of their minds, and every few minutes she has a 'fit' where she would just basically shake from side to side. She let slip to a nurse that she didn't want to go to school that week, so she was faking an illness. Since she was refusing to eat, the attending wrote up an order for a nasogastric tube (which was inserted and then removed by her in a matter of minutes), and we prescribed her sugar pills because her parents wouldn't let us transfer her to psychiatry or discharge her. She finally left after four days.
"One common way..."
One common way to figure out if someone is faking abdominal pain to get opioids goes kind of like this:
"Having some belly pain?"
Groans Yeah 10/10!"
Pushes on belly
Groans louder "That really hurts! Now it's a 14/10!"
"Okay, I'm going to listen now with my stethoscope!"
Places stethoscope in same spot where I pushed and pushing with the stethoscope bell even harder than before
Learned that trick and it's interesting how many people forget that they need to start faking again because they just think I'm focusing on listening to bowel sounds.
"Here's your Rx..."
Every Doc/Nurse will tell you the same answer:
- Patient knows the exact name of the narcotic they need to help with the pain.
- They have tried every other drug and nothing helps.
- Their heart rate is 75, bp is 124/77.
Me: "Here's your Rx of Extra Strength Motrin. Have a nice day."
Patient: "I'M GOING TO F*CKING SUE YOU!"
Frequently, at my hospital. We get state funding to serve the underprivileged, so all the homeless come here. We have a lot of "frequent fliers" that will come in and fake symptoms to get food, a bed to sleep in, or drugs. Most really don't even want drugs though, they just want food.
"As soon as someone says..."
As soon as someone says they have an allergy to Tylenol or Advil. Raises all kinds of red flags...generally see this when someone is addicted to pain meds.
"Am a nurse."
Am a nurse. The fakers always say they're not faking and can put good language to their 'symptoms ' genuine sufferers are less vocal about their illness and aren't as drug seeking even though they deserve to be.
"Husband is a paramedic..."Giphy
Husband is a paramedic and he gets it a lot, like many others have stated, when the patient knows the painkiller they need by name, something is up.
Another one he says is when they refuse the green whistle. It's a fast acting temporary pain relief that paramedics use as both pain relief, but to also give the patient a distraction. If you're in legitimate pain then you suck on the whistle, you don't start up a debate on the effectiveness of IV painkillers vs painkillers you inhale.
A story he came home with once was a guy who supposedly fell down one step and was lying on the floor screaming in pain. They could hear him before they even arrived, from a street away. The second they walk over his screaming goes from "AHHHHH AHHHHHHHH" to "QUICK, BRING THE MORPHINE! THERE'S NO TIME TO LOSE!"
"I worked peds..."
Obligatory: am nurse. Pseudoseizure is our nice way of saying you're faking a seizure. It's usually pretty obvious because a seizure is really hard to fake, but you'd be shocked how many people do. Anyways, if you lift a seizing persons arm above their face and drop it, it will land on their face. They are unconscious (tonic-clonic seizure) and will not protect themselves. Funny though, if they are "pseudoseizing" their arm always manages to juuuust miss their face. I worked peds and these were the worst because the parents bought it hook line and sinker and we had to tell them their kid was a faker. I had one arrive by helicopter once.
"It's a big part of healthcare."
By experience, daily. It's a big part of healthcare. We call things conversion disorder that are malingering because we don't want to mess with lives too much, but it's a huge thing. And you know it when you see it. Then when we doubt ourselves we pull out unusual objective or semiobjective tests. When someone is faking an illness though, it usually points towards a larger problem which deserves an attempt at treatment, although it's unfortunate that resources were wasted in the meantime.
"People aren't as clever..."
People aren't as clever as they think they are. We understand both disease and human behavior as sets of patterns. If you don't know the patterns as well as we do, your desperation stands out.
"When you tell them..."
When you tell them they can't go home until XYZ, they will suddenly find a miracle and voilà.
Anecdotally, they usually assume you're faking if they find no evidence of a problem. Most endometriosis patients get accused of faking / drug seeking / being crazy for years before being taken seriously.