It's a medical professional's job to care for others, providing a calm safety net to reassure us we're in safe hands and all of our pain will be handled. However, there are those who take advantage of this job responsibility. They fake symptoms, hoping for some misplaced attention and, occasionally, drugs. Thankfully, experienced doctors and nurses know how to figure out when a patient isn't being totally honest.
Reddit user, u/LushLover13, wanted to know what signs to look out for when they asked:
Doctors of Reddit, what are the dead giveaway signs that someone is faking?
You Shouldn't Be Able To Hear Me Right Now
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My sister is a pediatric audiologist and this is my favorite story of hers.
Apparently, sometime in elementary school (usually the early grades), a ton of kids like to fake hearing loss. Like not just "oh, I can't hear the teacher." Full on, want to get hearing aids, etc.
Anyway, she explained to me that based on the way she plays the tones, you can usually tell if someone is faking. Especially when they just pretend they can't hear anything. But it's not 100%, obviously, because hearing loss patterns can be really weird.
However, she's caught a number of kids simply by saying, "okay, so I'm going to play [a random number] of tones and they'll go in both ears. I want you to say 'yes' if you hear it and 'no' if you don't."
It's Not The Same When You're Down Under
Your Chest moving if you're pretending to be in a coma, (former floor nurse)
You should still be breathing during a coma, right?
Well yes, but it is smaller movements that you wouldn't be able to replicate without some sort of electrode it should also be known, that. In a coma your breathing is in an Agonial state. (Sounds similar to Vader in a way) if your breathing heavily to get the sound, a well trained ear and eye will motic
Don't Want The Cure, Only A Temporary Fix
They are hesitant about things that would fix their pain and want drugs in the meantime.
Also, when I look to see what they've been prescribed recently it has dozens of opioids from as many doctors.
Source; I get about 1 drug seeker a week.
That's...That's Not How Seizures Work.
Not a doc, but an EMT.
Had a patient with "seizures". Showed up to her violently and non-rhythmically shaking in the bed. Gathered history from husband who denied hx of sz. I'll leave out the other hx that kinda clued me to faking for this next bit.
Now, part of my assessment for sz like activity is to check a blood glucose. However the patient kept pulling her finger in when I was trying to stick it. I casually said "ma'am if you don't keep your finger extended I may stick you with this needle (JUST A LANCET) in the webbing of your fingers and it's going to hurt I need you to hold your finger still". Lo and behold her index finger extended and stayed still, while the rest of her shook. Bg was WNL.
She also tried to feign unconsciousness but the arm drop test (not sure the actual name, if anyone knows) said otherwise.
Followed up later and the ED said this patient was a frequent flyer and she became belligerent and left AMA after she was denied versed and oxy.
What Are They Asking For?
I'm a nurse on a floor that deals with a lot of chronic and acute pain patients.
Most recent instance was this lady from a few weeks ago that was apparently splitting the Oxycodone we were giving her in half in her mouth and then when the nurse's backs were turned, she would stuff it in a pill jar. A night nurse caught her in the act and all of her sh-t had to be searched. We found 20 half tablets of Oxycodone she had been stashing. She told us that she was "saving them for her family in case they need them because it's just so hard to get an Oxycodone prescription these days."
I had her a few days after that, and she was having some abdominal pain (STAT x-ray showed only gas. She just really needed to fart.) But she was screaming, claiming it was a 10, and making a huge f-cking scene. She DEMANDED Dilaudid through her IV, and she wanted it to be pushed fast. Huge red flag right there. She wanted the high, not the relief. Doc straight up said he wouldn't give her Dilaudid because she was already on so many opiates. She then demanded Lorazepam, still through her IV of course. Doc was like fine whatever, just one time and only a low end dose.
I was flushing her IV with normal saline first (to make sure her IV was patent) and she leans back and is like "OOOOoooo that's so much better already". Hadn't even given her the Lorazepam yet, smdh.
If You Need Help, Just Be Honest
Not a doctor but a therapist. For some reason adolescents like faking DID (formerly multiple personality disorder). It's a pretty rare and debated diagnosis in our field. I've seen people fake it by mimicking how it's portrayed in movies and on tv. Red flags are them telling you, "I have multiple personality disorder" and, of course, not meeting the actual diagnostic criteria. Some people feel like the common diagnoses aren't big or special enough to accurately represent their struggles, so they cosplay something worse.
Whatever you're working through is a big deal to us! If you feel like you have to fake or exaggerate your symptoms for your therapist, consider finding a different therapist.
Need To Fix The TV Before Having A Seizure. Right.
Nurse here, I had a teenager overdose on Zoloft and start having strange seizure like episodes. What made them particularly strange is that they all followed a predictable pattern of onset. First, he would lower the bed, next he would turn the tv volume down, and finally he would check to see if i was nearby. There was pretty severe thrashing about without any abnormalities in breathing, heart rate, pupils and he was still able to communicate with me throughout the entire episode. Unsurprisingly, EEG also failed to show any abnormalities.
Just Something To Casually Say Aloud In The Room
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"If someone is truly unconscious, their thumb always wiggle"
Just say that out loud to yourself
Moms: I always know when you're lying because your ears turn red when you lie.
Kids: cover their ears when they lie
Usually.
When someone says he has a migraine and yet has a normal blood pressure reading. Although unrelated, the stress and pain from a migraine will usually cause a localised hypertensive event. Therefore, a normal blood pressure reading is a dead giveaway sign that the person is faking it.
None Of This Matches Up
EMT here, I've had a hypochondriac patient and his main tell was his reaction to what his complain was completely inappropriate. He called saying he thought it was a GI bleed (something you won't be able to tell by itself). His words were "I can feel my intestine bleeding I'm going to die and I can't breathe"
SpO2 (% of O2 in your blood) was 97% in room air, blood pressure 130/80 ish (normal range, in a bleed like a GI it would drop significantly) and he had no history of GI issues (hernias). We get him in the truck and he begins to scream at the top of his lungs (if your GI hurts you wouldn't do that)
Completely inappropriate behavior and vitals for the complaint
Be Skeptical, Not Cynical
Nurse here
Found out that if a patient is faking unconsciousness hold their hand over their face and let it drop. If faking the hand always misses the face.
Have also found patient having a convincing seizure, but ruined it by putting their head up part way through to see who was looking.
That said, with all the fakery out there it can be really easy to get jaded and cynical and its really important to ensure that we dont miss stuff
Knowing Exactly What They Want
When they ask for a specific medication, typically an opiate or other strong pain relief medication, especially when you as the practitioner haven't even mentioned any need for medication. Textbook answers for any and all questions. Demanding ____ med and not realizing what the scientific name the doctor recommends instead is something like aspirin or similar.
Knuckle To Chest
If someone is unconscious, make a fist and rub your knuckles against their sternum (chest bone). Put some pressure behind it and rub quickly up and down (up towards chin, down towards belly button). It's called a sternal rub and is incredibly painful, but won't harm the person. It very, very hard to completely ignore and continue with the ruse of faking being unconscious.
The only more sure thing is asking your partner to hand you the eye needle to take some ocular fluid while they're passed out so they won't feel the pain of the needle in their eye.
Tank_Girl_Gritty_235Tricky Tricky Tricky
My wife is a doctor and she had dealt with people faking things like one of their legs simply not working.
The trick is to tell them to do some other thing with a positive phrasing making it seem like doing so will prove the patient's story is true, while it proves the opposite. this works for both people who are actively faking it and people who have subconsciously convinced themselves the problem is real.
For example, if they say their right leg can't move, you first ask them to try lifting it which they try and obviously fail to move or flex any muscles in it. Then you act intrigued and say something like "now your left leg is the one that works fine right? go ahead and lift it up for me for comparison." While they are doing this, you still casually have your hand on their right leg which you had placed there when you were feeling for any activity when they "tried" to lift it. Now when the person is laying there and lifts their left leg to prove their right one doesn't work, they will naturally flex their right leg to provide balance with their left leg in the air. If they are able to flex their right leg then but won't even flex it when they claim to be trying to move it, then you know their leg still works you just have to narrow down if they realize are faking it intentionally.
Just Because It's A Seizure Doesn't Mean I Have To Be Uncomfortable
Not a doctor but a paramedic. Tons of calls to the jail for inmates with "seizures", I lift the arm over their face and let it go they'll move it to prevent hitting their face or I'll lightly brush their eyelashes and they'll twitch to it
Even Wiping The Butt?
Whenever the symptoms aren't there when the patient doesn't know they're being watched. I had someone fake a stroke recently and walked in on her walking around her room independently (after pretending to be limp on her left side, letting us take complete care of her and wiping her butt for her).
It was wild, y'all
Fake It If You Want, I'm Still Sticking This Needle In You
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I'm not a physician but a paramedic. Honestly I don't really care if you're faking as long as its halfway believable. I'm still going to treat it as the worst case scenario. Faking a seizure? You'll get a full set of vitals, a blood sugar and a shot of benzos. Theres lots of different types of seizures. If you call 911 because you're in extreme pain and want an ambulance ride I'll put the good drugs in your vein hole. I'd rather give 100 drug seakers a 100 mcg of fentanyl than withhold it for the one person that really needs it. Can I tell if someone is faking? Yeah, most times but it goes both ways. If you go too hard I might assume you have a legit life threatening injury and sedate, paralyze and intubate you. Or start IV's in you jugular or shin bone.
Fake it if you want but traction may vary.
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