Two nights ago, I was watching a programme called ‘Medical Anomalies’ (yeah, I watch creepy things all the time) on the TLC channel. In that episode, they showed the story of two people crying bloody tears. One of them was a young boy in America and the other was a woman in India (puts a whole different spin on when your mum says ‘if you like, cry blood’ right??). Both stories were similar, in that their families were doing everything and spending a lot of money to get to the root of the problem and possibly a cure. There was just this very small difference; the woman was faking it! She was referred from one hospital to another, till she was finally referred to a tertiary centre in another province. Her husband used all of his savings to take her there, and you could see that the man had reached breaking point.
The doctor carried out a lot of tests on her and while he couldn’t find anything wrong with her eyes, he found a serious pathology in her abdomen that required urgent surgery. He had this theory that, she was using an obvious and scary ‘condition’ to draw attention to the real problem which was less obvious, and that perhaps she had been complaining about her stomach before, but no one listened to her. She had successfully kept up this ruse for about three years; having many episodes and fainting spells in a day, and had stopped doing house chores or looking after her family. Her little boy had now become her caregiver, hitting her head any time the severe headaches start (apparently, that’s a traditional Indian cure for headaches). But this doctor told her husband that she had to have urgent abdominal surgery and he also prescribed an eye drop for her that was just a placebo.
She didn’t have any episode of shedding bloody tears while in the hospital and she hasn’t had any after the surgery, and they continued to apply the eye drops religiously.
I started to think about the many patients I have seen over the years with their different fake stories and fake symptoms and non-existent illnesses. The medical term for this is to ‘malinger’ and there have been a couple of times when the diagnosis written in a patient’s case file has been malingering, nothing else. Such patients usually respond very well to placebos.
But what happens when the shoe is on the other foot?
What happens when there really is something wrong with the patient and the doctor cannot see it or is just dismissive of the patient’s symptoms? That can be very distressing. I should know; I have been on the receiving end.
Some years ago, I started having palpitations. Very mild, easily controlled with the medicine I was given by the cardiologist. But after a couple of years and increasing doses of the medicine, I was getting worse. The hitch was that my tests were coming up clean. I had had series of ECGs and Echocardiograms. The ECGs were always normal, I had one echo that had a few problems, but nothing to explain the symptoms I was having. By this time, I was having worsening breathlessness, my chest x-rays became abnormal, so another set of doctors were wondering if I was developing adult-onset asthma. So, I was placed on asthma medications. The breathlessness improved, but the palpitations worsened.
One day, during one of our outside postings at Wesley Guild Hospital Ilesha, I had severe palpitations and breathlessness. I called the cardiologist who was in Ife and he told me what to do and then told me to go and get a prescription from the hospital, when the worst of the attack had passed. I went to the hospital and met the doctor on call. He examined me and figured there was nothing wrong with me. So, his diagnosis was ‘Medical Students Syndrome’. This is the special aspect of malingering that is reserved for medical students.
The explanation is that medical students sometimes want to try out the conditions that they are taught in class. And when I tried to explain to him that these issues had been going on for about three years, before I even knew what the word ‘palpitation’ meant, and that I was under a cardiologist’s care, I was informed that the implication of that was that I had superb acting skills, enough to fool the whole managing cardiology team. It was ridiculous because my cardiology lectures were more than a year behind me. I endured fifteen minutes of lecturing about the dangers of malingering and indulging in MSS, after which I was allowed to go, without the prescription (he assured me that his wife used to exhibit MSS symptoms before he met her, and nothing ever happened to her). Needless to say, I didn’t die that night.
About six months later, it occurred to the Senior Registrar that I should have a Holter ECG done. Lo and behold, there was a diagnosis and it wasn’t malingering! We adjusted according to the diagnosis and all the parties involved heaved a sigh of relief!
So doctors, before you quickly dismiss a patient’s concerns and symptoms as being fake, consider whether you have done everything possible for the patient and even then, let your mind be open to that slimmest slightest possibility that there is something you’re missing.
To the real malingerers out there; we’ve got your number!
This piece has appeared on the doctor’s blog and the opinions expressed in this post are entirely hers.
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