human behavior

New words for the patient who isn’t ‘sick’

Posted in Health & Medicine, New Word by humanb on October 1, 2009

houseThere are few things more annoying than the doctor who is quick to assume a patient is faking. Real doctors are not like House. They are not nearly as rude or flagrant in their violation of medical ethics; but more importantly, they don’t always have the answer. You, the patient, see the confident, well-dressed professional with the air of invincibility, but in the back office they are looking up your symptoms and the current management of your disease on UptoDate. Later that week, your doctor and all of his colleagues in the specialty will convene for a weekly meeting where they will discuss their respective cases. Your case will be reviewed, and he will ask at least a half dozen other doctors their opinion on your situation. Sometimes they find an asnwer. Sometimes they don’t. And when they don’t, sometimes they wonder if you’re faking it.

Symptoms are what a patient feels: “I feel hot.”

Signs are what a doctor can elicit on examination: “The patient has a fever.”

When you have symptoms and no signs, doctors can get suspicious. The responsible doctor first exhausts the medical reasons why you might have symptoms without signs. But doctors are human, subject to prejudice, and prone to suspicion – particularly if your presentation doesn’t correlate with anything from their education and experience. There are a few different scenarios in which a patient reports symptoms that cannot be explained. One of these, is when a doctor just hasn’t found the answer – either because his knowledge is imperfect, or because modern medicine is a work in progress. This is one scenario. But here are some others:

Malingering

Malingering is the intentional production of false or exaggerated symptoms motivated by external incentives, such as obtaining compensation or drugs, avoiding work or military duty, or evading criminal prosecution. Malingering is not considered a mental illness. (eMedicine article)

I’ve heard doctors suggest a patient is malingering on more than one occasion. I can recall one patient in a rehab ward who had suffered a legimitate head injury and required some rehab. The gentleman spoke minimal English, but enough to impart that he had significant neurological impairment causing severe weakness in his arms that would prevent him from going back to work. Unfortunately for him, the patient didn’t know allied health professionals can indirectly test for weakness with electromyography (EMG) and nerve conduction studies. Caught and discharged.

Factitious Disorders

Factitious disorder refers to the psychiatric condition in which an individual presents with an illness that is deliberately produced or falsified for the sole purpose of assuming the sick role. Patients with FD waste precious time and resources with lengthy and unnecessary tests at a high cost to the system.

…. The modern history of FD began in 1951, when a clinician (Asher) described case reports of patients who habitually migrate from hospital to hospital, seeking admission through feigned symptoms while embellishing their personal history. He assigned the name Munchausen syndrome to this condition after Baron von Munchausen, a well-respected, retired German cavalry officer who had tales of his life stolen and parodied in a booklet in 1785. (eMedicine article)

There was a patient recently evaluated at my hospital by a psychiatrist for factitious disorder. She had an extensive history of invasive procedures to investigate chronic pain – including multiple exploratory laparoscopic surgeries of the abdomen and pelvis. The patient with factitious disorder doesn’t seek to avoid work or other responsibilities, nor does she seek any form of compensation for injuries. Rather, she seeks simply to be taken care of. She wants to be ‘a sick person’.

Somatoform Disorders

Somatoform disorders represent a group of disorders characterized by [real] physical symptoms suggesting a medical disorder. However, somatoform disorders represent a psychiatric condition because the physical symptoms … cannot be fully explained by a medical disorder, substance use, or another mental disorder. (eMedicine article)

Patients with somatoform disorders truly perceive or have symptoms, and if they present to a doctor, do so in good faith. The most well known somatoform disorder is hypochondriasis.

Hypochondriasis

hypochondrium (Greek hupokhondros)

hupo (under) + khondros (sternal cartilage)

The core feature of hypochondriasis is not preoccupation with symptoms themselves, but rather the fear or idea of having a serious disease. The fear or idea is based on the misinterpretation of bodily signs and sensations as evidence of disease. The illness persists despite appropriate medical evaluations and reassurance. (eMedicine article)

ab_region

Interestingly, hypochondrium means “under the sternal cartilage”. In anatomy, the hypochondrium refers to the left and right sides of the upper abdomen. Ever notice that the stereotypical hypochondriac holds precisely that part of the body as they complain about ‘terrible aches and pains’?

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One Response

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  1. mike rankin said, on November 10, 2009 at 1:36 am

    surprise you never mentioned or used the word most people know when talking about people who think that their sick all the time


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