People who work in healthcare (eg: nurses, RN’s, paramedics) what do you guys do if you know a patient is faking their injury/illness?

7 comments

1. We ‘treat’ then refer them to psyche to be evaluated.

2. Mandatory ‘I am not the person you are asking, but…’

   Saw one of those workplace documentaries once which followed the work of paramedics. Some guy was pretending to be unconscious but he was holding his eyes closed really tight so the paramedics knew it was fake – unconscious people don’t resist when you try to pull up their eyelids. Despite them telling him that they knew he was faking it, he continued to do it lol.

3. So there are seizure-like episodes that are not volitional, but that can be caused by stress.

   That aside, it gets complicated. Usually we have to take people at their word, within reason, at least initially. Basically one has to weigh up the harms of further investigation against the possibility of missing things.

4. My wife (ex-A&E nurse) use to say the sickest patients were the quietest. I imagine people faking it are loud and obvious

5. Unfortunately it’s very difficult to address this. I guess a large part of it is it’s far easier to treat their condition than it is to bring up the fact you think their condition is not real. It’ll almost certainly certainly destroy the patient-professional relationship and lead to a complaint.

   It is worth noting however that not all “fake illnesses” are consciously faked by the patient. For example there’s a psychiatric condition called non-epileptic attack disorder or pseudo-seizures. To the patient they are genuinely experiencing a seizure. But from a physiology point of view, they aren’t, they’re making conscious movements of their body.

6. There’s any number of ways we use to tell if someone is faking it. I’m a paramedic. I obviously work in emergency medicine, so if our methodology is a little different than other branches of medicine, but I imagine other providers have a similar headspace when it comes to malingering patients.

   We still treat you appropriately. If you look at me with a heart rate of 70, blood pressure of 120/80 and your skin is pink, warm, and dry only to tell me that your pain level is 10/10, I am probably going to give you Tylenol for the pain. Normally our pain medication that we go to for severe acute pain is fentanyl or morphine, or even ketamine if it’s still not controlled with an opiate.

   We have to treat patients complaints but we also have to treat based on their presentation and also be sure that the presentation is collaborated by objective data that we gather during examination. Malingering can also be a noteworthy symptom of psychological disorder or addiction. Believe it or not faking pain or illness can in fact get you treatment, albeit the treatment will likely not be for what you came expecting treatment for.

7. You just keep an eye on them until they get distracted and stop.

   Most people get very bored very quickly. Non epileptic seizures recover much quicker if someone isn’t giving attention etc