Saturday, August 21, 2010

Auntie Jo's Guide to Faking Neurological (and other) Disorders

Friend, are you feeling bored? Dissatisfied with your life? Vaguely disappointed by everyone and everything? Do you think you ought to be getting more attention from your family and from strangers than you do currently? Do you need a vacation from responsibility for a few days? How about your meals brought to you in bed? Does that sound good?

Well, Friend, do I have an offer for you! In a few easy steps, you can waste tens of thousands of dollars of resources, undergo unnecessary and sometimes unpleasant testing, and contribute to the inefficiency of the American health care system! You'll get all the attention you want and then some! You'll have people waiting on you hand and foot! You'll get visits daily from attractive young men and women! Just read this first:

Auntie Jo's Guide to Faking Neurological (and other) Disorders:

1. Remember to be consistent. If you present to the emergency room with a pronator drift, be sure that that pronator drift either stays the same or improves very slowly over time. Pronator drift testing is a cornerstone of the neurological exam, and drifts don't get better suddenly, only to worsen in a few moments, then improve again.

2. The same goes for unilateral weakness. Keep track of where, exactly, you're supposed to be weak. Having your leg give way and land you on the floor is an excellent dramatic touch, but only if it's the same leg every time. Again: consistency is key!

3. Retrograde amnesia rarely shows up in the absence of head trauma (internal or external) or really, really good drugs. It also rarely presents in a person with no other deficits. Try not to bring out the big gun of amnesia unless you're in danger of being discharged.

4. Beware the CT scan and MRI! They might just show that you have, indeed, no basis for your extremely interesting neurological exam. Watch out for the MRI especially: it's best to avoid being scanned by telling the tech at the last possible minute that you have a pacemaker, artificial joint, or bullet fragments in your body. It doesn't matter if you forgot to include that on your medical history before; you won't have to get scanned for now!

5. Don't forget: Migraines and somatic pain are for amateurs. There are too many non-narcotic options for treatment these days, and too many neurologists who are themselves migraneurs. Go with something more exotic, like the classic ipsilateral/contralateral/whateverlateral "falling out" syndrome.

A quick couple of notes on other disorders:

1. Rheumatoid arthritis generally affects more than one side of the body. Although a good-quality deformity can be achieved in one hand with time and self-harm, it's best to create problems on *both* sides of the body.

2. Blood tests and X-ray results have no place in your concept of reality. Even if radiology reports and test results come back normal time after time, keep insisting that a test you had at some hospital (the name of which you've conveniently forgotten) at some undefined time in the past was indeed positive. It'll create doubt and the need for even more exciting testing.

3. Never, ever admit to having any psychiatric diagnosis. It makes diagnosing your current illness that much easier. Instead, insist that you're fine, just fine: your hospitalization will be dragged out for days (or weeks) that way!

Happy Hospital-Hopping!

6 comments:

woolywoman said...

Actually, RA is always symmetrical, but can exist with OA which is not.

As for the rest, well, what can I say. seems like it would be easier to read to little children, take up gardening, or volunteer at the food bank. But, perhaps I am just unimaginative.

messymimi said...

If all of my kids grow up, there are no more kittens to bottle feed, the church doesn't need volunteer hours or a janitor any more, all books disappear from the face of the planet, and I have absolutely nothing else to do to keep me occupied, I will refer back to your excellent ideas.

Anonymous said...

My favorite was a patient who was having "seizures". After a 30+ minute seizure she had no desats, and was able to get up to the bathroom and talk on the phone immediately post ictal. She also had another about an hour later in which we watched her on our monitor shake for 2 minutes, peek over the side rails to see if anyone was watching, then go back to shaking for several minutes until no one came and she got bored and stopped.

Anonymous said...

sounds excellent

- especially for the full moon time, 'I hear voices telling me to kill myself' malingerers (translation= "I need 3 hots and a cot" (3 hot meals / day and a bed)) that usually present when very busy ED dept struggling to cope with the sheer numbers in the dept.

-might give me something different to triage.

anj said...

Hot damn, but it really sucks to be actually physically ill when you're also mentally ill.

It's how people like me (schizophrenics and such) end up with pneumonia, because that flu cough isn't real...

(Although I try not to ask for any pain medication no matter how much it hurts. I know what the stereotype is. I'll power through it somehow.)
Most of the time, even with broken bones, it's hard to get treated with compassion when you are crazy, and heavily tattooed, anyway.

Anonymous said...

this post is sadly hilarious and hits home - can Trigeminal Neuralgia be faked? I believe that someone I know has factitious syndrome and TN is the latest in a decades-long contrived illnesses. This person is textbook Munchhausen's not Malingering and has gone so far as to undergo brain surgery in a neighboring state based on what many people believe to be faked pain and feigned illness. visits to "many experts" in various states, FB lamentations for pity and now, drumroll! is unable to move the arm opposite of the side of the brain operated on. now, duped older relatives are stressed out over the months of physical therapy it will take - what can be done to finally expose this kind of fraudulent attention-seeking behaviour?