These Redditors from the medical field came together to share the moment they realized the person in front of them was putting on a show. And whether they were malingering or actually believed they were suffering, one thing is for sure: The stories about them are a total roller coaster.
1. Fake The Faker
As a paramedic, I always have a trick up my sleeve. I had a girl in my district that would fake seizures all the time. I knew exactly what to do to get her to "wake" up. I'd usually put normal saline in a nebulizer and fog up the back of the ambulance while telling my partner that the anti-seizure mist was on and she should be all better soon. Funny how she woke right up every time.
2. What A Snake
I knew a kid who was in a therapeutic wilderness program and faked a rattlesnake bite by poking two holes in his hand with a cactus needle. The guides bought it and he had to be evacuated by helicopter. The doctor gave him anti-venom even though they could obviously tell the kid was faking it.
This jerk ended up costing his parents $50,000 over nothing.
3. Casting Aspersions
Doctor here. Fakers are difficult to handle. Adult fakers are usually quite sad affairs, and there is really no satisfaction in exposing them. There’s this young guy in my town who has a weird and unexplained obsession.
He fixated on getting casts—but that’s not the weird part. It’s not about having one, it’s about GETTING one. He has come into different ERs claiming an injury, but there are never any objective finds. Then he usually gets a cast—since he is in pain, he gets one for pain relief—and then comes in multiple times because "he got his cast wet", "the cast hurts" and so on, and gets another one. He has done this so many times that he is now well-known by most staff and doctors in the ER.
I met him once, and since I hadn’t looked at his patient history beforehand, I believed him and sent him to the relevant examinations. And even if I did know his history, it would be wrong of me not to trust him, because this time the injury might just be real! It's more important for me to protect myself, even if it means that some extra work is done for nothing—and in my country this guy doesn't pay the actual costs of having these x-rays and ultrasounds.
4. The Drop Test
My wife is a doctor and cared for a lady who was trying to fake a coma. I thought it was hilariously effective that one of the tests they did to determine if it actually was fake or not was to hold her hand over her face and just drop it. Apparently, a patient who's actually in a coma will hit themselves in the face…but hers just ended up back at her side.
5. One Is The Loneliest Number
I remember during my second semester in nursing school we had a rotation at a primary care facility. We had a patient who came in on almost a weekly basis and he had lots of different problems—nothing major but enough that he felt he needed to come in and talk about it and talk about a lot of other things that were not related to his physical problems. It was only later that I learned the heartbreaking truth.
It turns out the guy lost his wife a few years back, had no job, no friends, his kids never called or visited, and his entire family was back in Iraq trying to not get blown up. All he really needed was to come in and have someone check him out and just feel that there is someone out there who cares about him.
We checked his problems and then we talked to him and recommended that he try some social events at the local activity center and things like that and he promised he'd look it up—but he still came back.
6. Making Miracles Happen
I had a girl fake falling down the stairs and being unconscious. We got there and right away things don't look right. I can pretty much tell if someone is truly unconscious or faking just by looking at their facial tone. It's a subtle thing but if they're faking it's like looking at a 5-year-old pretending to be asleep. Also, she'd wound up seated just right against a wall at the bottom of the stairs. Not a mark on her.
I had a student so he's going through his trauma survey and wants to trauma alert her. From his point of view she's had a fall and is head injured and unconscious. Fair enough.
So I step in.
I give her a hard-sternal rub. Imagine someone grinding their knuckles into the center of your chest. It hurts. Just a flinch, barely noticeable.
I touch her eyelashes. I've found that a truly unconscious person will not blink. Fakers will flutter. She fluttered.
Everyone's getting ready to immobilize this girl. There's six firefighters there, my supervisor and me and my partner. I stop everyone".
Ok Jessica, I'm not going to call a trauma alert and bring half the hospital down to look at you when you're faking. Open your eyes".
She sits up. "Sorry".
Firefighter says, joking: "Holy smokes! It's a miracle"!
7. Knee-Deep In Liess
I work with teenagers. We once had a girl that did this all the time, to the point of being pathological about it. She was complaining of stomach pains and they kept her in the hospital running a ton of tests, more than once. You could tell the nurse knew she was faking, but I think for legal reasons they couldn't dismiss her without a diagnosis. But one incident was the absolute funniest.
That was when she was army crawling across the dorm floor because she claimed she was paralyzed…from the knees down.
8. Manifesting It
It was the fifth grade, and I called up my mom who was at work. I told her: "My throat hurts so bad, I don’t think I can go to school". She called me in sick and made a doc appointment. The doc did the strep test twice. Once for the immediate results, the other to send to the lab.
I did not have it at the doctor’s office, but a few days later the lab results came in. Apparently, those tests came back positive, and I had to take an antibiotic!
9. My Spidey Senses Are Tingling
My husband is a paramedic and the worst story of faking it I heard was a girl who lived twenty minutes away had an ectopic pregnancy. An ectopic pregnancy is where the egg was fertilized outside of the uterus, like in the fallopian tube. Now in this case it's very painful, by 9 weeks you have to have surgery to remove it or possibly die.
So the girl called—and what she said was outrageous. She claimed that she had an ectopic pregnancy and she was 20 weeks along. My husband and the ambulance go down there and pick her up. He knows it’s a lie but he is still required to give her a ride. So she walks over and hops in.
Then her creepy-looking boyfriend comes over and tries to get in. Right away my husband knew something was off. At that point my husband stated that he couldn't get into the ambulance. The girl starts throwing a fit saying he's the father of her baby and needs to come. My husband says "I'm legally required to take you to the hospital, I'm not legally required to take anyone else, so he is not coming". She says: "Oh well I feel better then and guess I won't need to go to the hospital anymore". That’s when he realized it—he’s pretty sure they were going to try and mug him during the ride.
10. Brave Barry
There's a guy that used to always invent illnesses to get an ambulance ride out of the boonies and to the hospital in town. Of course, he gets free ambulance rides, and of course, they have to go pick him up no matter how many stories he tells, because what if this one isn't a lie?
Let's call this guy Barry. So Barry phones in, and the call goes something like this:
"I need an ambulance"".
What is it this time, Barry"?
"I'm paralyzed"!
"...Barry, if you're paralyzed, how did you call us"?
At this point there's a long pause, before..".
It wasn't easy"!
"Okay, Barry. I'll send my guys"".
I don't want to scare my wife, so tell them to meet me at the end of the driveway"".
Barry, if you're paralyzed, how are you going to get to the end of the driveway"?
Here there's an even longer pause, before he triumphantly exclaims: "I'll crawl on my lips"!
11. Heads Up!
My dad was a pediatrician, and one time a lady brought her teenage son in because he claimed he had gone blind. My dad checks him out and right away can tell he's faking; just to be sure, he used some kind of device that you spin and it makes your eyes start to saccade—like a rapid involuntary eye movement to track it.
After he was finished the kid was protesting that he really couldn't see. My dad knew exactly what to do.
The kid had taken his shirt off for the exam, so my dad picked it up and tossed it to him-- and the kid caught it. His mom was not very happy.
12. Lesson Learned
My grandmother, when she was a kid was extremely well behaved, never did anything wrong.
One day there was this chemistry test that she was SO worried about that she started faking really bad pains in her side.
She ended up being rushed to the hospital so that they could remove her appendix, all the while she was yelling that she was lying about the pain from the test.
They took it out, and she claims that she's never lied since.
13. Like Pulling Teeth
It’s no surprise to anyone that we get many patients who are seeking pain meds and will feign pain in every way possible. Somehow, they're allergic to morphine, but not the stronger stuff like Dilaudid. I do have one way to test them, though.
After I step out of the room I will speak loudly to the nurse within earshot of the patient and say: "We're going to give him some pain medication, if he has itchy teeth then we should give him double the dose". About five hours later, the nurse calls me and says that the patient is complaining of burning and saying his teeth itch.
14. Wake Up And Smell The Ammonia
Classic case is people claiming they've lost their sense of smell to get insurance money—but there’s an easy solution. I do a simple smell test with coffee/bourbon vanilla and ask if they smell it—they will deny. Then let them smell ammonia. They will claim that they don't smell anything.
The thing is, the "smell" of ammonia isn't perceived through the smelling nerve, but rather through pain induced in the nose. Even if they DID lose their sense of smell they should be able to "smell" ammonia…unless other parts of the brain were damaged, too).
15. Addicted To Ailments
I've had a full-blown argument with a patient in the middle of a hospital hallway where I told him there was nothing wrong with him and that we would be discharging him home. He threatened some lawsuit, which wouldn't have happened, and then huffed and puffed and checked out the next day. Later, I found out the twisted truth.
He had Munchhausen's, and had previously had about 11 surgeries for vague complaints with completely normal pathology, and was in again for something totally made up. The nurses cheered me—literally, they were watching the fight through the windows of the nurse station and cheered when he walked away.
16. The Power Of Compassion
My dad is a doctor and he helps patients "fake" it—all for a heartwarming reason. I know a lot of times he is asked to prescribe a breathing treatment. The treatment requires an electric machine and therefore electric companies are required to provide someone with power, even if they cannot afford payment. He often writes the prescription for a few extra weeks to give people time to catch up on their bills.
17. The Placebo Effect
I had a patient in the ortho unit who was well-known in the hospital due to his constant admission for pain-related diagnosis. It's always a different kind of pain every single time.
Exactly on the dot, his call light went off and asked for his 3:00 pm pain medication and it was a heavy dose. The patient asked me to inject it fast. I told him, "No. You'll stop breathing".
He got mad and demanded another dose. I told him, "I will look at his chart to see if there are other pain medications that are safe to give him".
I walked out of his room and he was swearing his lungs out. His doctor was in the hallway talking to another of her patient. She looked at me and smiled. I just nodded. I started to prep meds for another patient when his doctor came in and took out an IV of saline.
Right away, I noticed something was off. She labeled it with the name of a pain medication. Then she handed it to me and told me to follow her. We went to the patient’s room and the doctor talked to the patient about his pain condition. This guy straight up lied about not having any pain meds for the past 4-6 hours even though everything is documented in his chart.
She then told me to give him his "pain meds" and apologized to the patient. The patient again told me to inject it in faster. I looked at the doctor and she nodded yes. I pushed all 10 ccs of saline and watched the patient.
He had this relief look, eyes rolling back, exhaled loudly, and thanked me. I tried my best not to laugh, then wrapped up everything, and walked out the door.
18. Magic & Misdirection
If I have a patient complaining of pain and from their story and presentation, my spider sense starts tingling that they aren't legit, I like to throw some distractions into my exam.
For example, if they say they have excruciating 10/10 shoulder pain and practically jump off the table when my fingers barely touch their shoulder, I'll make a big spectacle of palpating another part of their body, saying "I'm going to examine your knee now! Do you feel any pain here? How about here? Over here"?
Meanwhile, my other hand has never left their shoulder and I'm pushing on it with increasing pressure. If their pain magically disappears while they're distracted, I tell them that I'm going to write them a prescription for MiraLAX, because they're full of it.
19. From One Diagnosis To Another
When I was working with a neurologist, a patient came in who had a diagnosis of multiple sclerosis since the 80s—but there was one weird detail. She had never had an MRI. She came in to get restarted on her medications that she hadn't been able to afford. She presented that day being unable to talk or open her eyes, she was sitting in the corner unresponsive but conscious during the exam.
The doctor did an MRI, which will show demyelinated lesions in MS patients. That’s when we made a disturbing discovery. There were none to be seen. He brought her in and showed her the MRI and explained that stressors, etc, cause conversion disorders and asked about stresses in her life. It turns out she was abused as a kid, symptoms started around age 20. After lots of crying she "came to" and was able to walk and talk.
In this case, confronting her was part of her therapy. She was referred to psychiatry.
20. Connect The Dots
There's a story my father, who was a doctor, always loved to share. It was about a woman who claimed she had chickenpox, as she had some red dots on her face and body.
After doing a thorough physical exam, he prescribed a red marker so she could "finish the job".
21. Suffering In Silence
Sometimes fakers have what is called a Conversion Disorder. These people are NOT consciously creating their symptoms. They are manifesting internal stress/conflict via their bodies in an unconscious mechanism. These symptoms can be shocking, even to a doctor. I remember as a medical student when a gruff Italian-American guy came into the ED with left lower extremity paralysis and numbness. CT head and MRI clear. But his symptoms were truly impressive.
Me and the resident were jamming the heck out of his shins and soles with the writing end of a ballpoint pen. No flinching. Nothing. He felt nothing. We also learned that his wife had just divorced him and gained custody of the kids. He claimed it was stressful but he was managing it by not dwelling on it. He had no emotional outlet for his loss...so his body expressed that loss in a loss of function.
Profoundly sad. These are the fakers to whom your heart goes out—the truly brokenhearted and emotionally mute. Thus you can see the importance of distinguishing between fakers.
22. Classified Information
This is a military story. We can't get sued by the patient, so we do stuff a little differently when someone is faking it just to get out of physical training. So this one little jerk of a private keeps coming in complaining about his back. We give him all the usual tests to make sure there is no problem, there is none, kid just wants a "no run-jump-march" profile.
So the doc takes him in the back and says he isn't supposed to do this but he is going to try a top-secret new medical machine on him. It will destroy back pain and has never failed. The kid agrees to it. So doc takes the kid in the back and makes him lay down with his shirt off under the x-ray machine.
He then proceeds to cover, and I mean cover, the kid with maxi pads, after that sprinkles glitter all over him. He then turns on an ordinary black light and makes the kid wait like an hour before coming to get him. The kid said his back never felt better and thanked doc for his help.
The kid came back in for "treatment" once a week for the next couple of months before deployment. Good times.
23. And The Oscar Goes To…
In med school, one day we were doing rounds in neurology, the doctor—think of a shaven Bud Spencer—had a bad day and was in a bad mood. We go into a patient’s room and he is faking being in a coma, just lying in his bed unresponsive. His family is there and says he was fine 20 minutes ago.
He checks pulse and breathing and everything is right. He calls his name a few times, loud, no response. The doctor tries the putting their hand above their face and letting go trick, but this isn't the patient's first time faking. He lets his hand hit him, but reacts a little. At this point, we all know he is faking it—but the doctor is cranky and mean and is going to go to extreme lengths to expose him.
The doctor announces loudly to us "Do you know the difference between stupor and coma? Coma patients don't respond to pain".
It started with a few light slaps, and calling his name loudly. Last one was not so light.
Second, he puts his fist against the sternum of the patient and rubs. Try this on yourself, hurts quite a lot. The patient twitches his face but still fakes being in a coma. Bad move.
The doctor gets out a pen, gets the patient’s hand, puts the pen sideways on top of one of the nails and presses hard. This hurts like heck. The patient flexes his face really hard, moves a little, and flexes his body. By now the doctor is talking to him normally saying that he knows he is just faking. But he is devoted to his role.
The doctor just says forget it and goes to the next room. The next day we come back and the patient was totally awake, responsive, alert, well-mannered and extremely helpful.
24. Pop Til You Drop
Med student here. The resident taught me a good way to catch fakers of workplace injuries that just want the compensation money. A lot of them will come in with "pains" and "injuries" in their knees and such. If he suspects them, then all he does is pull out his stethoscope and say "I'm just going to listen to your knees for popping sounds associated with type 1 knee injuries".
He'll then press the bell head into the knee relatively hard while telling them he's hearing strange popping noises. Normally if it's a faker, they won't respond with significant pain as they think they already fooled the doctors. Of course, this works with other body parts, too.
25. Music To Her Ears
I met a woman once who was deaf. She had an interpreter and everything, and was a fairly cool person. I had a crush on her interpreter, so the three of us would hang out pretty often. I loved listening to music, and someone told me a way to have her be in on it too, she would hold a balloon close to the speakers and could feel the music. Her interpreter thought I was a genius, and we all had fun doing this often.
Well, no relationship happened, and I didn't see either of them for a couple years. I ran into the interpreter one day—and she told me the bizarre truth. The "deaf" woman was actually faking it! She's been faking a hearing loss for many years, to get attention and interpreter "friends". I felt like an idiot thinking back on my balloon-music device. She heard every note just fine. It’s the weirdest thing I had ever encountered.
26. Out Of Gas
My brother used to claim he had ADHD and that he couldn’t sleep. He would ask for sleeping pill, but one day we ran out of sleeping pills and mom gave him a pill that reduces gas and bloating. He thought it was the sleeping pills and kept taking them…and falling asleep like a baby.
27. Patience Is A Virtue
I used to volunteer in the ER and there was some very long wait times, it wasn't uncommon to take 4 hours to see a doctor. Sometimes if they think you’re in real trouble you get rushed through, but it’s not always easy to tell. One time a man came in clearly in a lot of pain asking the nurse for help, he had to wait like everyone else. Yes it sucks but that's the reality of our health care system.
I had been volunteering there for a while so I had seen my fair share of people trying to skip the line, but watching this man I couldn't help but feel that there was something seriously wrong with him. So maybe after two hours of this poor guy hunched over writhing in pain, he finally loses consciousness, passes out in his chair, and falls on the floor. I run over to him scared for the guy but angry at the same time, thinking about the wait times.
Just as I reach him, one of the paramedics that was in the waiting room pushes me aside and says: "C'mon, buddy this isn't our first rodeo". The dude wakes up immediately and says: "But I need help"! To which the paramedic replied, "So does everyone else in here, it’s the ER".
The guy was faking all along.
28. I Can See Clearly Now…
As an optometrist, I would say 80% of girls ages 6-12 fake that they can't see because they want glasses. We call them malingerers. As a student working in a pediatric department I struggled every time one came in but I quickly learned how to trick them. You basically make a sample pair of glasses with no prescription in them and magically they can read 20/20. We also have other tests we can do to figure out if they need an Rx. In the end you let the parents know they see fine and the kids never walk out with a smile.
29. My Bag Of Tricks
I'm an ER doctor and unfortunately see this stuff way too much. One thing I do is carry around an ammonia capsule in my scrubs. The ammonia capsule is very noxious and seconds after popping it the whole room will fill with a horrible odor so your eyes start watering and your nose burns and generally you try to get as far away as possible. When someone comes in faking a seizure, and it's usually ridiculously obvious, I break the capsule and without saying anything shove it as far up their nose as possible. Usually, the "seizure" activity stops and they immediately sit up trying to dig it out of their nose all the while yelling "get it out it burns"!
One of the other tricks I use is for people who claim they feel they can't feel their legs. About six months ago, I had a 25-year-old guy with a history of multiple admissions at other hospitals for unclear reasons who fell and said he couldn't feel his legs anymore. It was fake of course and so I was talking to him about how we were going to get him out of there and he kept yelling "But I can't feel my legs"! I knew just what to do. I grabbed a 16-gauge needle (ie, a huge needle) and stabbed his big toe with it. He immediately yelled "Ow"! and then looked back at me and said "Oh, but I didn't feel that".
So we put him in a wheelchair and dumped him in the waiting room and hallelujah…he was able to walk home.
30. Safe Haven
Psychiatrist here. A lot of people come into the hospital claiming they may harm themselves to get admission to our psych ward. A hospital is a warm, nice, place with people who tend to your every need, warm food 3 times a day, with unlimited snacks in between. Our psych floor has therapeutic recreation (arts, crafts, Wii, garden etc). So, it’s not too hard to see why folks would fake it to get in.
We had a frequent flyer in the ER say he was going to hurt himself, I asked him what his plan was.
"To end my own life".
"How"?
"by jumping off a bridge".
"You say this every time, yet you never do it, how do I know you really mean it this time"?
"You’re saying I won’t do it?! How dare you!! Watch me, you let me go and I’ll do it tonight"!
"Okay okay, we’ll bring you into the unit. Are you feeling depressed"?
"Of course I’m depressed. There’s nothing to live for. I’ve been wanting to go for days".
"Okay, I need to know your code status for your admission. Do you want us to do CPR, defibrillate, intubate, ventilate, and other invasive but life-saving procedures if your heart were to stop or your breathing were to cease"?
"Yes"
"Why? I thought you wanted to die".
All I got was a blank stare in return.
31. Miracle Cure
I think the most annoying faker was this woman who would just stay in bed all day. She wouldn't even try to get up. She actually liked being catheterized. She would take notes while talking to nurses, doctors, and other allied health professionals and claim to be a lawyer. She did some clerical work for a firm, I later found out.
She always needed pain medication (legit) and get them on the dot, every 6 hours. She would complain constantly. She was mostly irritating—but I knew just what to do.
Magically, I got the social worker involved who said that she has to leave the hospital soon. Since she was not able to walk or complete any activities of daily living, she must be transferred to a nursing home as soon as possible.
She magically got out of bed and began to walk with a walker. With a little bit of help—not even intensive rehab—in one week she was walking and doing everything herself. In total, two weeks later she went home.
32. Driven To Distraction
I was with an emergency doctor evaluating a teenage girl complaining of terrible abdominal pain, so bad she was wailing and squirming while he was trying to do an ultrasound of her belly. So he finishes the exam and starts chatting with the patient about other things. Meanwhile, he is wiping the ultrasound gel off her belly with WAY more pressure than he had used during the exam. It didn't bother her at all while she was distracted.
33. One Awkward Moment
My dad is a doctor, and I figure I might as well share one of his stories here. My dad says most the time patients will end up making it obvious on accident. One guy came in complaining of back pain and was clearly hoping to get a slip for paid leave. My dad was suspicious but went about business as usual. The guy did the usual act: whimpering about his back, grabbing at it, just overall exasperating way too much. However, at one point, he dropped his glasses. No big deal but, he suddenly had no problem bending over to grab them. My dad just awkwardly stared at the man and then there was a long silence. The guy knew he messed up.
34. Fake It Til You Make It
One time, I had a patient whose symptoms and physical exam almost 100% convinced me he was faking. He told me he had an imaging study done. I work in a facility that has computerized access to imaging records in the entire country dating decades back. I was not able to retrieve the study on the computer system. Undeterred, I called the facility where the patient claimed he had his study done.
The facility had no record of this patient ever coming in, let alone a physical copy of the study (which would be in the holding facility in case the computer system ever failed). When I finished my investigation into this matter, I returned to tell the patient I was not able to retrieve this study. His first comment? "That's funny, my LAWYER didn't seem to have any trouble". That type of response was the last thing to confirm that he was faking it.
35. A Swing And A Miss
This person claimed intractable back pain, was "not able to walk", despite having an intact neurological exam, was moaning and groaning to an extent that was completely unreasonable, and was otherwise extremely dramatic and pretending to be completely handicapped. He had been on worker’s comp for a good year at that point and claimed his back pain made it impossible to work.
I started making some small talk about sports-related injuries in the waiting room, then asked the patient if he played any sports. He replied that he played hockey. I steered the conversation away towards something else, then casually asked him if he had been playing this winter. His answer blew up his whole story.
"Yeah, I played yesterday in the rec league and we won"! I documented what he said and sent it to worker’s comp on the spot. Of course, I didn't comment on that at all. He didn't even notice he said that.
36. Wake Up Call
The funny thing was last week we had some kid faking seizures in the ER. He and we all knew it, but the parents refused to believe it, so the ER doc poured a cup of ice water on the kid and he yelled and jumped up. It was hilarious to watch.
When I was a kid which was a while ago back before you could really get into trouble for it I saw a lady in the ER when I was in for stitches and this lady was doing a terrible acting job screaming about pain and wanting something for it, the nurse slapped her in the face and she was shocked but somehow those horrible pains went away. Every once in a while, my mom brings that up because she was there with me.
37. Smile, You’re On Candid Camera
I work in a clinical laboratory where we record people's movements on video. We know people are faking when they change the way they move in front of the cameras. Sometimes we leave cameras running as they leave so that we capture the difference. The patient is often then referred to the psychiatry department.
38. They Let Their Fingers Do The Walking
My dad is a dentist and regularly has random people (not patients of his) call him up to ask for pain medicine for toothaches and such. He usually suggests that they schedule an appointment sometime that week, or if the pain is really bad, to come to his office immediately for emergency treatment.
The people actually in pain will show up, but the people who aren't will get all angry and yell at him for not just calling in a prescription for them. It turns out a lot of pill heads will just call down the list of dentists in the phone book until they find a dentist willing to dole out prescriptions without a proper dental exam.
39. The Off Switch
I edit medical assessment reports. You'd be amazed at how terrible people are at faking symptoms. They will come in and claim that their back is so sore that they can't bend over, and then when the assessment is over they bend over and put their shoes back on with ease. They will limp into the examination room and forget to limp on the way out. Sometimes the symptoms they come up with are so stupid no one could possibly believe them. The one I’ll never forget is the guy who sprained his ankle and claimed to be suffering from sporadic bouts of full-body paralysis ever since.
40. Snitches Get Stitches
I work in physiotherapy. This female patient comes in for an evaluation. She has crutches from a car accident but no visible injuries. She passes all tests including a supine leg press with a decent amount of weight. The place I worked at had a terrific relationship with its patients since many had come for years.
A phone in the office rings not ten minutes after crutch-lady leaves. It’s another patient that we had in around the same time that day, saying: "Hey just wanted to let you know I saw that woman with the crutches walking fine with them resting on her shoulder".
41. The Truth Behind The Fakers
Sometimes someone will come in complaining of weakness, numbness, or faking a seizure or stroke. If you know your neuroanatomy, are competent in a good neuro exam, and have seen real presentations of these illnesses, these are often the easiest to discern real versus not.
For instance, I have this guy who has a drug and depression problem who always comes in fake seizing when he is under stress; I just stick a nasal trumpet in his nostril, which he manages to pull out while "seizing". You cannot do that during a real seizure. I have another lady who comes in a fake coma from time to time. If you lay her flat, hold her hand above her face, and drop it, it should hit her in the face; with her though, it miraculously drops to the side instead. There's a psychiatric term for this called conversion disorder, where they truly believe they're having these symptoms; I'm not a huge believer in this diagnosis though. To me, it's more supratentorial, ie…not real.
42. Not In On The Joke
My wife is an ER nurse and my favorite stories are the fakers and "pain seekers".
Apparently, one of them used to come in and spout of in a matter-of-fact way all the things that doctors had told her were wrong with her—but she had one hilarious blind spot.
In the long list were terms that meant "totally faking it" in Latin and, she would say, "They told me I suffer from pseudo-seizures".
Allergic to everything that isn't narcotic too, funny how that works.
43. Tales From The ER
I work in two large level 1 trauma EDs in a major metropolitan center. Every day I see people who are using the ED for either minor problems or who likely have secondary gain. We have patients who we see every 2-3 days for the same symptoms and who you know by their first name basis. It is very difficult to distinguish one from another and usually we do our best not to declare that one person is "faking it" and another is "sick".
Often times we do have to work up people who we are pretty sure at the end of the day are not going to have any pathology and will be just fine if sent home because there are the ones who surprise you. It is a very, very difficult job. Dealing with people who are not feeling well, with family members who are scared, and with people who often have psychiatric or emotional or social issues underlying or overlying their medical diseases is a huge challenge. In addition, there is the overwhelming fear of litigation and pressure from above to satisfy patients, as Press Ganey scores are a large factor in hospital reimbursement.
We do our best to ensure that we really do find the people that are sick, that we don’t overspend and over-test patients who we don’t believe are (over-testing is expensive, leads to false positives, and has its own associated morbidity and mortality).
In the end though, your judgment and your conversations with the patients are the most important, and sitting down and talking with your patient is the most important thing. It’s not wrong if your doctor sends you home and says come back if you get worse. That's very often the CORRECT thing to do.
Now have I dealt with people who are full of lies all the time. And usually it depends on what they are looking for and how much effort I want to spend fighting. Usually I will draw the line at pain medications but I am very liberal at work and school notes. I often know someone is not seriously ill when I write them, but If people want to be gone from work, that’s their business.
They are adults and can run their own lives, if they can live without their income or the repercussions of multiple absences at work that’s their business. At least that's my view of it. I could spend 20 minutes in the room arguing about you and haggling about when you should go back to work but that’s 20 minutes that the next person is waiting who might be sick and actually need me. There are a large number of people who come to the ED for work notes.
Now I also see lots of people who have complaints that you know physiologically are not real. They have numbness that is non-dermatomal. They have normal labs or vitals. They have stories that don't make sense. This is a case by case in how you have to handle it but typically in those cases, I take an especially good history and physical to ensure I am not missing anything and then do my best to send the person home with good instructions but minimal testing.
Now there are a lot of people who fall in the gray area in between that we have to test and who sometimes have real pathology that other doctors have missed. It’s hard. But that’s why we go to school for so long to be able to do it.
44. The Candy Man
I specialize in pediatrics. Anytime it’s a school day and they insist they are too sick to go to class, they think ice cream and/or video games will fix them right up. A lot of my clinic patient's mothers just call me and let me mention the possibility of a shot and they seem ready to go to school. When a kid is feeling really terrible, even a shot seems good to most of them. My little fakes usually feel better when I give them "medical" lollipops.
45. As Easy As Child’s Play
My sister works in a pediatric emergency room. Two-year-olds don't fake it, but they do act lethargic and annoyed after staying in bed for a week, so it can be hard to tell if they're all better or still in real pain. She says part of her job is to start playing a game with a ball and another nurse with enough enthusiasm that the kids will get up and try to play along if they're feeling better.
46. Ten Out Of Ten
Former EMT here. I had a patient who claimed to have pancreatic cancer, resulting in severe abdominal pain. Here’s a couple of quick tips: If someone says their pain is a 10, they're usually faking. People in real pain generally throw out an 8 or 9 for some reason. Anyway, he refused any tests and refused to give us his doctors name or current medication, just demanded morphine.
Yeah, no. He got to stick it out until a doctor pronounced him just fine and called the authorities.
47. Hit And Run
I was an intern in the emergency department years and years ago. A mother and two daughters, who were about 5 and 8 years old, came in after a "car accident". I enter the room and right away I know something is off. The kids are playing normally and the mother is reading a magazine. Upon entering, the kids get quiet, and mom puts a pained look on her face. She states that they were in a T-bone car wreck driver’s side that destroyed the driver’s door.
An exam of all three demonstrated pain WAY out of proportion to any signs of physical trauma…as there were no signs of physical trauma. I asked mom what make and model of car and color she was in for my paperwork.
I left the room, walked out to the parking lot, and made a disturbing discovery. I found her exact car, which showed no signs of being in a wreck. I copied down the license plate number, walked back into the ED, and asked the law enforcement officer in the ED to look up the license number. It matched the patient’s name.
I walked back into the room and told them that I didn't see anything wrong with them and started to discharge them. The mother was insistent on obtaining pain meds and I told her no. Then I sent them on their way.
I'm sure they never paid their ER bill and probably went to the next ER, where a doc was too tired to care and gave them what they wanted.
48. Mouth To Mouth Therapy
When I was a lifeguard, some kid was found drowning. Everybody crowded around this 15-year old-boy, who was apparently unconscious. I wasn't believing it initially, but who is to say that he wasn't? So the guard rubs his sternum with her knuckles before starting CPR. That’s when I see it. His mouth moved ever so slightly. I tell her to keep rubbing, and lo and behold he rolls away and the paramedic sits him up, does his assessment, and then kicks him out of the park. I guess he wanted some mouth-to-mouth action from the lifeguard!
49. Is It Raining In Here?
An EMT I worked with was transporting a frequent flier who was faking being comatose after faking a seizure. The medic decided he was sick of her faking it and took out a bag of saline a poked a small hole in it. What he did next was totally deranged.
He then loudly unzipped/rezipped his fly and squirted her with the saline while her eyes were closed. She didn't react but as soon as they got into the ER she sits bolt upright and screams "HE PEED ON ME"!
The medic points and screams "I TOLD YOU SHE WAS FAKING"! The medic had a reputation for being kind of a loose cannon, so I would believe the story…but I can't see keeping your job after something like that.
50. Scared Stiff
I was working as a paramedic and had a 12-year-old patient who was clearly pretending to be unconscious. I loudly told his mom, who was right next to him, that I was going to hold his hand over his face and if he was really unconscious rigor mortis would hold it there. His reaction was hilarious. We wheeled him into the ED with his hand sticking straight up.
We would also have patients who said "yes" when asked about every symptom, so we had a standard in the region where we would ask if they got pain behind the eyeballs when they urinate. If they said yes, we could tell the hospital that they were "positive for retro-ocular dysuria", and they knew what was up.
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