From: km@cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: "Problem Patient"
Date: 5 Oct 92 12:12:17 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Distribution: usa
Organization: Univ. of Pittsburgh Computer Science

In article <1992Oct3.135230.27052@genie.slhs.udel.edu> nancy@genie.slhs.udel.edu (Nancy Lebovitz) writes:
>
>How do you tell the difference between someone with Munchausen's and
>someone with a problem you don't know how to diagnose? (I'll take your
>word for it that Munchausen's exists, but I've also heard too many
>horror stories from people who got told their real diseases were
>delusional.)

1) People with Manchausen's sometimes can be caught faking things -
adding blood to their urine specimens, for example. We once had a
patient with unexplained "fevers" who had a thermometer sitting in
a glass of warm water - every time the nurse took his temperature,
he waited for her to leave, and switched thermometers. Recently there
was a lady whose rash from "lupus" was able to be rubbed off by the
attending physician - it was makeup.

2) They give you classic stories for particular diseases, just as
if they read it out of a book, which of course, they did. My favorite
was the guy who came in looking fine, not at all in distress, who
announced in a monotone: "I'm having crushing, substernal chest pain
radiating down my left arm and up into my jaw, accompanied by
nausea, vomiting, and diaphoresis."

3) They do not accept negative test results. Most normal people are
glad to hear that a test is negative, especially if a positive result
would confirm a serious disease. The patient with Munchausen's will
tell you that your test is wrong, or that they already had the test
somewhere else and it was positive.

4) They stay in the hospital forever, and just as you are ready to
discharge them, come up with a new complaint or "finding".

5) They come to you with "existing diagnoses" that were made by
"specialists" who are always "more qualified" than yours truly.
They also never can produce records from these doctors. Usually there
is no evidence on physical examination to support the diagnosis.
Multiple sclerosis is a favorite one. "Heart attacks" is another.
Last year I saw a patient with four diagnoses that he insisted he
had for which there was absolutely no evidence.

6) They use wheelchairs when there is nothing on physical examination
to indicate a reason for being in one. They also demand every conceivable
medical appliance that could even remotely be appropriate to their
"condition" even if they don't need it. Few people who actually
need wheelchairs will demand you get an elevator for their home.

7) They go from hospital to hospital, staying long lengths of time,
getting every conceivable test run, until people wise up to them.
The pattern is usually to only stay in one hospital once, and to
keep the hospitals far apart, typically, across the country.
When you finally get the records from the other hospital, you find out
that the other physicians suspected the same thing you did, but it
is too late, because you've already run $50,000 worth of tests.

8) Anything the doctor does to dis-establish the diagnosis results
in the patient running to the patient advocate's office. "Dr. Mitchum
is out to get me - he doesn't believe any of the experts!"

 -km