This article is based on the AskReddit question: "Doctors/nurses of Reddit; What is the most obvious case of a patient 'faking it' you have ever seen?"
Let's scrub in, shall we?
Hard To Fake It Through The Pain
Had a patient fake guillain-barr syndrome - ascending paralysis. She ended up in the ICU and I was her nurse. I was a new grad and had to put a catheter in her bladder. She had to pretend she couldn't feel a thing and I could see the pain in her eyes. Turned out she got into a fight with her husband and as he was walking out of the house she fell on the floor to make him stay. I don't think she meant to take it so far, but she didn't know how to back out.
Another ICU pt - she was a nurse on disability and would fake seizures, which are really hard to fake. She would hold her breath and shake and roll around on the bed. Her O2 saturation dropped to the 70s from not breathing (and maybe the sensor wasn't picking it up well as she was shaking) and we told her we'd intubate if she couldn't protect her airway and she would miraculously stop seizing. Never acted postictal and could remember the whole seizure and everything that was said..She told me she would call my manager since I said during one of her "seizures" we didn't need to give her ativan.
Guy came into the ER the other day FORCEFULLY trying to get himself to vomit. I'm talking over one hour of Exorcist-like wretching to get any stomach contents out. It was amusing for the first minute but then became really sad to realize how far this guy was going to get his fix for morphine.
Judgey And Jury
Get called for an unconscious intox's at a bar. Get her out to the ambulance, she shouts "I'M HAVING A SEIZURE" and starts waving her arms around. I tell her "people who have seizures generally don't announce it first." Her response? "You're being very judgemental, I was getting ready in case I had a seizure."
... gotta stretch, I guess.
That's Not How This Works
My mom's an ER nurse and she said once some crazy lady came in and complained hat she had the whooping cough. And whenever she coughed she followed it with a loud woooOOOP!"
We All Scream For Ice cream
5/15. Oooh that's a toughie. It's either:
12 or 13 year old kid was having "seizures," would have another every time the ER tried to discharge her, magically woke up when her father proposed getting ice cream with no recollection of what happened. Video EEG was negative of course.
Old lady pretending to be catatonic, was helping us transfer her from wheelchair to bed (i.e. was not limp) and when we held her hand over her face and let go she dropped it to her side (if she were truly out it would have smacked her)
A lot of pain fakers are obvious too but pain is a bit more gray area while the above have objective findings.
6/15. My partner at work is an Administrator with an ED Nursing background. She was called in to the ED one night last year to deal with a patient who was complaining of severe headaches and nosebleeds but was refusing to go for any kind of examination in favor of being admitted. They are pretty sure at this point that she is drug seeking as she refused to even lie in the bed. My friend left the room and was standing a few feet outside the patient's glass bay talking with the Charge Nurse when she noticed the patient turn around and hunch over. She subtly stopped the conversation so they could observe.
The patient turned around with more blood on her nose and blood on her fingers from where she had been reaching into her underwear and smearing period blood all over her face to fake a nosebleed.
Can You Hear Me Now?
I'm an audiologist, and it's fairly common to have people fake a hearing loss. With adults, it's commonly for worker's compensation/benefits. Children do it for attention or to get out of school for a day.
They are fairly easy to spot...patients will come in, conversing with me very normally, but the audiogram will show a profound hearing loss. We all have our tricks to get them to slip - I like to lower my mic volume to a normal range and mention that they dropped something when they're in the booth, they instinctively reach for it, forgetting that they shouldn't have heard it because of their "loss." We can also do an auditory brainstem response, bypassing the need for patient responses. A Stenger Test can identify those fakers that only have a "hearing loss" in one ear.
My favorite is when testing kids that are clearly faking, part of the test requires me to have them repeat words. So I present them at a normal volume and the kids are REEEAAALLLYY straining to hear them, then I slip in funny words like "buttcrack" and watch to see them smile because they clearly heard it.
Stroke Of Genius
Work in a hospital for prisoners. They will frequently fake chest pain to get in to the hospital, but sometimes they will try to fake other things instead.
Had a guy trying to fake stroke symptoms. Claimed he couldn't move his leg, docs examine him and he insists he can't move it. 5-10 minutes later I look in the room and he is walking to the bathroom. When he sees me, he immediately starts limping and acting like its hard to walk. Pretty sure he was discharged shortly after.
9/15. A nurse friend told me this one, this happened about a month ago. A woman and her boyfriend are rushed in by ambulance after being in a car accident. My nurse friend is with the boyfriend, who keeps yelling about his baby. It takes a minute to calm him down, but my friend gathers that the guy's girlfriend is pregnant. So they check for a heartbeat but don't hear anything. The woman keeps asking the doctor to check again. Both her and her boyfriend are in tears. Finally another nurse comes in with some of her tests results and announces that the woman wasn't ever even pregnant. The woman starts arguing, saying that yes she was pregnant and has been for a while and that the results are wrong. Turns out a few months back her boyfriend tried to break up with her so she lied to about being pregnant to get him to stay.
10/15. A girl came in complaining of 20/10 abdominal pain. Lab work all normal, pelvic normal, CT normal. I closed the door and curtain in her room, but kept a little crack where I could see her. Within 5 minutes she stopped yelling and screaming about her pain. I saw her on her phone, eating McDonald's, and walking around. This went on for almost an hour. She then heard another staff member outside her room and began screaming again. After being left alone for 5 minutes, she would stop. When I went in to discharge her, she said she was having a AAA and was going to die. She tried to rip down the curtain and then intentionally smacked her head on the computer.
Security escorted her out... She was back the next day.
Another one was the guy that said he was at a different hospital where they told him he was having a heart attack and needed morphine. But just before they could give it to him, someone came into the ER and started shooting, so he got up and ran. We called over to that hospital and they just laughed. Guy signed out AMA 10 minutes later.
There are some fun ones in psych.
The patient went into her room and, in a very obvious stage-voice (just loud enough for us to hear her in the main area), started saying random, unconnected sentences/phrases. Then she immediately came out, walked straight up to us and asked, "How do I know if the voices are real?" She would act perfectly normal when she thought we weren't looking, but as soon as we walked loudly up to her door she'd start "talking to herself" again. Yeah, no. That's not how psychosis works lol. Good try though.
Also there was the girl who "strangled" herself unconscious. There was no pressure whatsoever on her throat/neck. The doctor quietly snuck up to her, then smacked his hands together in a single giant clap. She jumped.
And another patient who had "seizures". She lay in bed, twitching, when I called her for lunch. I said all right, but if you lie there for too long you're going to be stuck with the vegetarian option. The seizures magically stopped.
Walk Away Shontay
When I was a resident, I had a patient in clinic that was doing that round-about thing patients do when they want narcotics but aren't going to directly ask for them. She would hint at having arthritis pain that "just doesn't seem to get better except that one time she took lortab" and that "you know, her friend gave her a Percocet once and it helped a lot" (never mind the fact that this lady was 100% functional despite "debilitating pain").
At the end of the clinic visit, when I offered a physical therapy referral and stronger NSAIDs (the actual treatment for osteoarthritis), she suddenly sat straight up, looked me in the eye, and said, "Doctor, I don't know how...but I'm totally paralyzed."
Seriously. She pretended that, all of a sudden, everything other than her mouth was totally paralyzed. She made us send her to the ER (but not before she had my nurse unwrap a peppermint and literally put it on her tongue because "her blood sugar felt low"). We had to lift this nutcase into a wheelchair (during which we could all feel her shifting and repositioning...not something a paralyzed person would do) and roll her to the ER to be evaluated for "sudden paralysis".
While in the ER, she suggested to the ER doc that maybe Lortab would fix her paralysis, and when the ER doc rightly refused this treatment, she got out of the stretcher and walked out.
Had an employee that was "allergic to everything" and a huge hypochondriac. She was such a headache that we ended up moving her desk way away from pretty much anyone else so she would stop complaining. One day, a lady walks by with a strong perfume, and our lovable hypochondriac falls out.
Predictably, EMS is called, and by this point our employee is laying on the ground rolling her eyes back in her head. Scary stuff if you didn't know she was literally insane.
So EMS arrives and they come over, put the O2 meter on her finger, and she's choking through her speech when they're asking her if she can breathe or not. O2 saturation was at like 97% or something like that. Medic goes "ma'am, there's no reason why you should be having trouble breathing right now."
They hung around for another couple minutes, then bounced.
Had a mother come in and INSIST that her child had Silver-Russell syndrome. You can go read on it. It's not that easy to fake, as it's a bunch of metabolic conditions mixed with congenital abnormalities.
The kid was small, but not that small (around 6th percentile). He didn't weight much (5th percentile). All of this, with a right arm length 2 cm more than the left side, were borderline criteria for Silver-Russell. Did genetic testing, which came back negative, but 30% of cases are negative.
So the deciding factor was one of the "soft" criteria of hypoglycemia. Once she heard about this (she printed out 30-40 articles on the disease), she came back with the kid in a coma. But when the kid was in the hospital, he was never hypoglycemic. He went home, and came back in a coma a few weeks later. Again, as soon as he was eating normally at the hospital, he was never hypoglycemic.
She starved her child into comas repeatedly for the diagnosis of Silver-Russell. She was also a "bougon", people who live off welfare and make a game out of it. By the way, she was in a wheelchair when at the hospital. Once I had enough of her bullshit and walked into the room after only knocking once. She was walking around normally and jumped into the wheelchair as soon as she saw me.
I believe it was for money since in Canada/Quebec, you get money when your child has a genetic disability.
Bills, Bills, Bills
Gentleman called 911 from a restaurant claiming he had a migraine and was unable to see properly. He was literally 2 blocks from a hospital.
I've had migraines, I'm sympathetic. On the way to the call I was planning my treatment plan so he would be more comfortable during the wait in the emerg.
He was waiting outside, in full sunlight, waving at us. Thanked us politely for coming "to his rescue". Sat in the well lit ambulance, chatting up a storm, making inappropriate jokes, and laughing. Stating the whole time he has 10/10 pain from a migraine, and that only Percocet works to reduce the pain. He has them frequently, and wouldn't you know it, he's run out of his prescribed medication, and his doctor is on vacation.
The chef from the restaurant he called from came out and asked for his information. Our patient was "unable to pay his bill, due to the pain." He conveniently had no ID he could leave with the restaurant, and only had his debit card with him. He promised to come back, once he was feeling well enough to tap his PIN into the machine, but right now he couldn't. The chef knew 100% the guy was lying, but couldn't do anything.
As someone who has had a vomiting, shaking, vision effecting, migraine in the past, he did nothing to convince anyone he was in actual discomfort. I actually would greatly prefer if he had said, "I ate a meal I can't afford, and I'm addicted to pain killers, can you please take me to the ER." Honesty would have gotten him better treatment from everyone involved.
Edit: We took him to the ER. He waited in the loud busy waiting room reading magazines. I'm from Canada, so his ambulance bill is mostly paid by the Ministry of Health. Physicians can sign a patient as "non essential" which would cause the patient to be charged for the whole cost. The MOH has no guidelines surrounding what is essential and what isn't, so the MD/Hospital opens themselves up to a lawsuit if someone decides to sue because the MD signed their ambulance trip as non-essential. So this rarely happens.
Add to that if the patient is receiving social services from the government or has no fixed address, they are charged nothing at all.
The studies have been done, Paramedics/EMTs in other countries can tell you, charging people does not reduce the frequency of illegitimate 911 use.
[Image credit: Denis Pepin / Shutterstock.com]