What to Do When You’re Patient Exaggerates - the Art of Diplomacy

What to Do When You’re Patient Exaggerates - the Art of Diplomacy Anyone who has spent any time working in a Health Institution will be able to regale you with tales of that one patient who was always on the verge of death, regardless of how minor their actual ailment really was. We’ve all experienced it; however, that doesn’t make it any easier to deal with.

Firstly, there’s the risk of the ‘Boy Who Cried Wolf’ syndrome - if you have a patient who habitually exaggerates symptoms, it can eventually lead to the tricky situation whereby it takes their health professionals longer to respond to genuine situations. Secondly, there is a risk that the exaggerated symptoms are masking another, real, complaint - sometimes this is physical, but often it’s psychological (and perhaps the core reason for the exaggeration).

It helps to understand the reasons that patients malinger in the first place, and there are several. Some are obvious, some not so much. However, understanding the reason behind the deceit can help you find an appropriate way to deal with it.

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The first cause that we will explore is malingering to avoid work. Although it’s easy to jump to the conclusion that your patient is simply attempting to avoid work (and in some cases, this may be true), there are other reasons that people wish to avoid their workplace.

If you suspect that your patient is exaggerating symptoms to extend the time that they are signed off for, it may be worthwhile to cautiously ask them about their feelings towards their work environment in general - how is work going for them? Do they have any concerns or worries?

It may be that your patient is experiencing work based stress that needs to be addressed as an individual complaint - as we all know, excessive stress can lead

to many physical and psychological disorders, and addressing this early on can avoid all kinds of health problems further down the road.

Workman’s Compensation Syndrome Another leading cause of exaggerated symptoms is, of course, financial. Does your patient currently have an open case, or intend to file for workman’s compensation? This type of malingering has become increasingly common in these challenging financial times. Although this is not a hard and fast guide, and you should always use your clinical judgment, there are certain features that frequently appear in these cases.

If your patient frequently misses appointments, has a range of very vague, nonspecific symptoms or appears hostile to Independent Medical Examinations, it may be worth looking a little harder at the circumstances of his or her claims.

You may also find that the illness or disability extends past the usual recovery period, and that the patient is frequently making demands for excessive treatment or benefits.

If you suspect that your patient is exaggerating their symptoms due to an ongoing WMC claim, it may be worth gently attempting to find out about their circumstances just before the injury. Were they experiencing financial difficulties, or was their appointment about to end? Were there any performance issues or concerns?

It is, of course, incredibly hard to prove that this type of claim is ‘fake’. Any concerns of this nature should be discussed with your clinical lead. It may well be that he or she already has concerns of their own, or might already have heard concerns from other team members or allied health professionals.

Mental Health Issues One of the most challenging and complex reasons for ‘malingering’ is of course genuine mental health issues. It is very difficult to actually call psychosomatic illness or ‘made up’ symptoms that arise from mental health difficulties malingering, because a patient who presents with a complaint that stems from this is actually unwell - just not in the way that they claim.

Furthermore, it can be very difficult to spot cases of this nature because the patient often wholeheartedly believes that they are very unwell. In some (fortunately rare) cases, they may even be deliberately contributing to their illness or injury, or taking deliberate measures to prevent recovery.

You may have noticed, for example, that your patient has a recurrent or very hard to treat infection - although this frequently happens and is completely usually completely genuine, it may be that the patient concerned is not taking or misusing medication, or even encouraging ongoing infection by deliberately reinfecting the wound.

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Someone who is depressed, or has alcohol or drug dependency issues will often have a chaotic lifestyle which means that they find complying with basic medication regimes very difficult. They may just not care about themselves enough to see the point in keeping up with the basic steps that are required of them to actually get better.

If you suspect that your patient is suffering from a mental health condition, then referral to the appropriate clinical team is without question the way to go. Many of the MH disorders that lead to self-neglect or self-harm require long term treatment of their own, and a holistic approach to physical and psychological problems is required in these cases.

Summary It is vital that you don’t feel that you need to deal with your concerns in isolation. Although it’s appropriate to talk to your patient and find out the background to their illness and injury, it’s not something that you necessarily have to tackle alone; if you feel that you have valid concerns about your patient’s symptoms or illness, you should first talk to your senior manager or

clinician - as previously mentioned, they may already have concerns of their own.

By all means, explore the patient’s background with them - after all, their care is your concern, and this is not about calling someone out as a fake. There are a whole host of reasons why someone might exaggerate their symptoms, and those reasons are often just as, if not more, complex than the original illness or injury that they presented with.

Attempting to find the root cause of ‘malingering’ may help you to discover other symptoms or causes of an underlying physical or mental health condition that requires treatment just as urgently as the one that originally brought them to their health care facility.

Sadly, despite this fact, there will always be genuine cases of malingering and it’s vitally important that these are reported as such. Although notoriously difficult to prove, these patients clog the system and delay treatment for genuine patients - as you will know, because these cases frequently take up far more time than genuine complaints, they often divert desperately needed resources from other patients.

The overall message here is to talk to your team - use your judgement initially, and then ask for advice from your seniors or clinical leads. Don’t feel like you need to do all of the leg work alone. Importantly, don’t feel like you have to be right; after all, this is one of those rare situations where it’s far better to be find out that you were wrong, and that your patient has a treatable illness that they will eventually recover from.

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