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26 Stories About What Doctors Do When They Are Convinced A Patient Is Faking It
Doctors not believing patients or underestimating what they are going through is an often talked-about issue, but sometimes folks do think it’s a great idea to just lie. So it stands to reasons that people who work in healthcare have a few ways to differentiate a real patient from someone just seeking attention.
Someone asked “Doctors, what do you do when you see a patient is obviously faking it?” and medical professionals shared their takes. Be warned, there will be some fairly graphic descriptions of medical procedures. Otherwise, get comfortable as you scroll through, upvote your favorites and be sure to share your own thoughts and experiences below.
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#1
As a doctor, NEVER doubt your patient until you can prove him wrong. He wants to feel better in someway (look up WHO's definition of health). I worked in a public hospital where sodium solution was IM was prescribed to patients that were suspected of faking catatonism. That hurts as hell (hypertonic solution in muscle). Instead, I did something more humane. I gave her crisis anxiolytics and referred her to a psychiatrist. It normally turned out they were left by the guy that left her pregnant with a second child while she comes from a low income house with no studies. That hurts more than your average headache.
As a doctor you have to understand something, people that fake diseases either feel the disease, or need the break from their world and can't handle their stress properly. Both type of people are sick people and need a psychiatrist, not a "man-up". At least they need a good heartfelt talking, some empathy. Even kids that call in sick too often must be running away from something THEY perceive as humongous and dreadful.
And besides, you ALWAYS have to clear up every physiological and functional pathology before even thinking about psychiatric and emotional problem. What if that person is complaining about a feet and headache because of a tumor?
Care for your patient's life as much as can, holistically, because they trust you blindly as someone that will make them feel better. Do your work and you'll avoid ethical, remorse and legal issues.
Edit: I'm from a third world country so that's why sodium solutions and the like (cheap stuff) are the "wake up call" treatment for fakers. Sometimes we can't even use CT (we don't have MRI scanner on public health) or nerve conduction test (neither on public health system) for patients with sure structural pathologies. Hell, yesterday there weren't enough catheters for emergency cesareans... But I know many psychiatrists that understand the importance of wholesome health.
The thing is that I'm not "good" doctor. We should hunt doctors that don't act like that, because it should be standard. Being ethical should be a job requirement, not an extra, just like speaking two languages should be a requirement for being a translator. "Look, he is an unethical doctor" should be meant to mean "Look, he is in jail or not a doctor at all".
Cat Palmer 1 minute ago
The problem with doctors assuming a patient is faking is that *doctors can be wrong*. A lot of doctors thought my sister and I were faking / exaggerating our illnesses. My sister passed several years ago, and I'm permanently disabled. We weren't faking, just experiencing a genetic condition rare enough first line doctors hadn't seen it before.
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#2
We get a lot of training for this in school for audiology. People fake hearing loss all the time to get worker's comp or money from the government for service-related hearing loss. Here's the thing: we can always tell. There are only a few specific ways that the way you hear through air conduction (when the sound has to go all the way through your outer and middle ears before reaching the cochlea) and bone conduction (when vibration of your skull sends the sound straight to your cochlea) can interact. People who are faking tend to pretend their hearing loss is flat across all the frequencies. If someone is pretending to have hearing loss on one side only there is even a special test called the Stenger that we can do. Basically you play sounds in both ears but the brain only perceives the louder sound, so as soon as the sound in the person's "bad" ear gets louder than the other ear, they stop responding.
We're trained not to ever let on that we know the person is faking. We blame it on the equipment, we move to a new sound booth, we tell the person that the test results just aren't matching up and we should have them come back another day. Basically you give the person every chance to tell the truth. If they never admit to the fact that they are faking, we can run a test that measures brainwaves in response to sound and prove their approximate thresholds that way. HOWEVER, some people have psychosomatic hearing loss, where they truly believe they cannot hear even though they physiologically can. In kids this can be caused by trauma or mistreatment, so even if we really think a kid is faking, we would never tell their parents that in case it meant additional mistreatment for the kid. There is a point at which we bring in social workers, psychologists, etc.
#3
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 its very painful, by 9weeks you have to have surgery to remove or possibly pass away)
So the girl called and said that she had an ectopic pregnancy and she was twenty weeks along. My husband and the ambulance goes down there and pick her up. He knows she's lying but he is still required to give her a ride. So she walks over and hops in. Then her tweaky looking boyfriend comes over and tries to get in. 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 if 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." My husband said the guy looked strung out as all hell and didn't want to get attacked in the ambulance.
#4
I'm an EMS pilot and the nurses/medics have shown me a couple of awesome tricks they use on fakers. When they are sure a person is faking that they are unconscious they will lift the person's hand up over their head and let it go. The fakers won't let the hand flop down directly onto their face. If they're out for real, it'll go straight down. Another fun one to watch is when a person's faking a seizure, the nurse will announce loudly that they are going to start an IV on a specific arm. It's funny to watch somebody faking a seizure with 3 limbs moving instead of 4.
#5
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 and could obviously tell the kid was faking it. This brat ended up costing his parents $50,000 over nothing.
Cat Palmer 6 minutes ago
Is that one of those 'therapy' programmes where parents ship their child off to the middle of nowhere without warning to live in forced deprivation until they agree to whatever their parents want from them? If so: well done, kid, for working out a way to escape.
#6
Paramedic/flight paramedic. I'm one of the weird ones. I tend to treat what the patient tells me, not my impression of their situation. I'm talking specifically about pain here. Our medical community has been trending towards demonizing medicated pain control, and I think that's one of our biggest shortcomings. Adequate pain control improves so many things, patient compliance, recovery rates etc. If someone tells me they're in a lot of pain, I generally believe them and treat accordingly. Percocet, T3, Diluadid, Morphine, these are *medicines* people.
SaraCapybara 3 hours ago
I have a disease that send me into the ER about 6 times a year. There's a cocktail of three dugs that always breaks my cycle. One of those d***s is Dilaudid. I have to advocate hard for it and some doctors are so anti pain meds that they refuse. If I have an ER visit and the doctors don't give me Diluadid, a return visit to the ER is always required. My disease causes a lot of pain on a regular basis but I still can't get someone to prescribe me pain meds.
#7
As a paramedic, I have been known to fake the faker.
I had a girl in my district that would fake seizures all the time. 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.
Edit: For those of you who feel like outing a faker is a bad medicine, get off your high horse. Paramedics deal with fakers, liars, etc on a daily basis and we'd be doing the public and ourselves a disservice if we just went along with it. Nothing about that story was dishonest, illegal or detrimental to the patient. Move along.
#8
Former paramedic. Fake seizure? "Oh my, it's too unsafe to move them like this. We'll have to put in a catheter first." And wouldn't you know it? A miracle.
#9
Doctor here. Fakers are difficult to handle. Adult fakers are usually quite sad affairs, and there is really no satisfaction in exposing them.
One story is a young guy in my town who has a wierd and unexplained obsession getting a cast. Not having one, GETTING one. He has come in to 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 hadnt 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).
TL;DR: Some people fake it, but since you have more to lose by exposing them you usually just try to be professional and move on to the next patient.
#10
3rd year med student here. Will be a doctor in ~15 months.
We respect the patient and try to formulate why they are faking it. Attempt to explain that we can't find an organic cause for their disease after exhausting reasonable tests. Even when we think they are faking it, we always keep in the back of our minds that this pain for say, may be very real for the patient.
No matter what you think, or what perceptions you have, very few of us are dismissive to your problems.
Geobugi🇰🇷🇰🇭 10 minutes ago
You need a much longer time to become a proper doctor, sunshine. Because you can not find a organic cause does not mean there is none. There are still so many things we do not know about the human body that is think it is outright arrogant to believe that you covered all possibilities. Just a small example, a friend felt allways very tired and gained a lot of weight. Conclusion, he is eating to much because he is maybe depressed, even if he told them he eating actually less than he used to. No one bothered to make some standard blood tests because he is male, he just can not accept that he is getting older. 3 years and many doctors later it turned out to be hashimotos. Rare with man, i admit but nevertheless something that could have been found much earlier if not every doctor he met told him he has nothing because they could not find something.
#11
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.
*-"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 of Miralax, because they're lying.
WindySwede 3 hours ago
Now they are going to this doctor: " If someone tells me they're in a lot of pain, I generally believe them and treat accordingly."
#12
My father is an EMT and told me this story:
There's a guy on the reservation my dad used to work on that used to always invent illnesses to get an ambulance ride off the reserve 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 false stories he tells, because what if this one isn't false?
Let's call this guy Barry, cause that's a suitably unpleasant name for an unpleasant guy (no offense, Barry's out there). 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!"
"*sigh* ok 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 gonna get to the end of the driveway?"
Here there's an even longer pause, before he triumphantly exclaims
"I'll crawl on my lips!".
#13
Not a doctor but I learnt that the best way to 'wake up' someone who 'passed out' is to squish down on their index finger on the nail.
It's a pain you CAN'T ignore but causes no damage.
This one has worked a charm when out drinking and someone wants attention.
#14
I am a dentist.
this is a huge generalization but for the most part, people who are only seeking pain meds tend to be of a lower income population. that being said, they almost ALWAYS elect to have a tooth extracted rather than restored because it is much less expensive.
It is often hard to get an infected tooth numb, so all i have to say is "ok i would be happy to pull this tooth for you, but unfortunately i will not be able to get the tooth fully numb and you are likely to feel a lot of pain during the procedure."
now, this is not really true, i can always get a tooth numb, it just takes a little longer sometimes. but if the person is faking it, they are unlikely to go ahead with the procedure, but if they really are in that much pain to begin with, they will do anything to get the tooth to stop hurting. anyone who has ever had a bad toothache will attest, it is one of the most painful experiences anyone can go through.
Lorius Interruptus 6 hours ago
This is pretty messed up. The fear of having dental work without anesthetic because we were too poor to afford reconstruction of the teeth ended up causing my husband's infection to go septic and he died. I've been a widow for 5 years because a dentist thought he was a d**g seeker when, in all reality, he was just terrified. This is so messed up.
#15
Depends how you define "sick".
Kid who refused to bear weight on his leg after a fall but otherwise wasn't complaining. Do two physical exams, a regular one (where they cry if you get close to it), and another one where you distract them. Sure enough when he was playing with bubbles he didn't notice me touching his leg.
Adults faking for pain meds, that's a bit more difficult. Emergency docs have to deal with this a lot.
#16
Critical Care physician.
Depends on the situation.
**Pseudoseizure**: Splash water on their eyes. Or, if you're meaner, apply nailbed pressure.
**Fake Blindness**: Some recommend "confrontation", basically waving threatening objects close to the face. One ED doc I know even recommended going at them with a needle. This seems as if it could become self-fulfilling. More subtle approach: several signs with letters and pictures; ask if the patient can see each one. Last sign features something obscene about their mother. Watch for change in facial expression.
**Everything else**: There's a whole body of literature about symptom validity tests. General idea: we can predict how a disease will act, and how it won't act. We know this better than the patient. If the patient has a disease, the disease will quickly teach him what he "should" be feeling and not feeling. If he's faking, it's tough to figure out the right set of symptoms on the fly.
Elladine DesIsles 2 hours ago
I hate the last paragraph! Sure, many medical conditions have one or more typical presentations and paths of symptom progression. But not all patients are going to be typical; there will always be deviations. Some may have been misdiagnosed, meanjng their symptoms don't "fit" the condition they believe they have. Many may have more than one overlapping medical issue, resulting in a complex interaction of symptoms. Not presenting in the standard fashion should never indicate that the patient is faking or not really ill. If anything, in an era where detailed medical information is readily available to would-be fakers with sufficient intelligence and determination, I would think that a "too perfect" presentation might be the real red flag.
#17
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 **the absolute best** was when she was army crawling across the dorm floor because she claimed she was paralyzed *from the knees down.*.
#18
As an EMT, if a patient fakes unconsciousness, we can say things like, "Alright we are gonna have to put an IV in his eye!".
#19
As a hearing doctor, we take whole classes at university in how to identify fakers, because hearing loss is one of the most common false claims for disability compensation, or kids who want attention / to get out of school. It makes sense that people would try, because even in legitimate cases there is usually no way to tell if anything is wrong just by examining the body; you have to rely on the responses the patient gives. But our techniques to detect liars have evolved right alongside their techniques for lying, and we pretty much have the upper hand at this point.
Some ways we can tell you can really hear, from easiest to most subtle:
- Especially for little kids, but it's been known to work for adults of less-than-exceptional intelligence: quietly whisper something like, "Do you want some ice cream when we're done?" 9/10 times, the guy who just denied hearing a 100 decibel tone will say "Yes, please."
- Also for the little ones, you can give them the instructions, "Raise your right hand when you hear the beep, and your left hand when you don't hear the beep." Then when you play a sound that's "too soft for them to hear," they raise their left hand as soon as you play it. Adorable.
- When you play those 100 decibel tones, watch them wince and "ouch" as they continue to claim that the room is perfectly quiet. Don't worry, it can't really hurt them, just annoy them enough to amuse me.
- Sometimes the patient does all the work for you, just from their behavior: people who honestly can't hear don't cup their ears and say "Whaaaaat? SPEAK UP!" like an old man in a cartoon. And when you do speech testing, it's entirely unique to fakers that they will only repeat the second half of two syllable words, like I say "airplane" and they say, "... something... plane?" Oh, like what, cowplane? Shirtplane? Last I checked there's only one common two syllable word ending in "plane," and people with hearing loss tend to get *better* at figuring things out from context, not worse.
- There's a test specifically designed to detect fakers who claim to only be deaf in one ear, which relies on that kind of patient's absolute unwillingness to ever admit hearing a sound on that side: someone with a legitimate hearing loss *should* hear this particular sound in their *worse* ear, not the better one. Especially since few people know about this one, if someone passes this, I take them 100% more seriously immediately.
- And of course, the real kicker is we can sedate you, put some electrodes on your brainstem, and prove beyond the shadow of a doubt that your brain is picking up the sound, but that's expensive, and you're a poor clinician if you let a case get to that point. Playing them psychologically is much cheaper.
And what do we do if we actually find out you're faking it? I personally try to be compassionate about it, because even though I would never try to pull something like that, the motivation is obvious, and you sort of can't blame them for trying. A lot of people realize they're in over their heads halfway through, and they appreciate getting an excuse to change their behavior, like "Oh, these headphones must not be working; let me give you a different pair." Then they start responding.
But if they take it to the bitter end, I still can't prove they are faking *intentionally* - there are possible psychological or neurological reasons for "non-organic hearing loss" that are truly beyond a person's control, no malicious intent whatsoever. So I just present the results in a neutral, non-accusatory tone, as honestly as possible, "We could find nothing wrong with hearing system biologically, but you report that you still have a hearing loss, so the issue must be deep in your brain where we don't have the technology needed to detect abnormalities." Then I make the referrals to an auditory processing disorder clinic or a psychologist as necessary, call it a day. The mere suspicion that someone is trying to deceive you, no matter how strong, is never an excuse to be rude.
#20
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.
In the long list were terms that meant "totally faking it" in Latin and, she would say, "they told me I suffer from psuedo-seizures."
Allergic to everything that isn't narcotic too, funny how that works.
#21
ER doc here. No matter how annoying or malignant the patient is, no matter how many times they've come in with the same complaints, or how full of BS they seem, you still have to take them seriously; even annoying patients can have real complaints. Also, I think it's overstated how often people come in just seeking narcotic medications. Usually people don't come in to the ER if they have no pain; waiting there for hours, especially in urban ERs, is not fun. They usually legitimately are feeling pain or have a legitimate complaint.
One thing that makes us suspicious is when a patient is observed to be comfortable or joking around when no one is around, but is in severe pain when I or the nurse gets there. When they come in asking for specific pain medicine, ie "I need 1mg of dilaudid IV with a 50mg benadryl chaser, that usually pings our BS radar (unless they have a legit pain etiology like sickle cell disease). Finally when they have pain until they are distracted, that's usually BS - when they're moaning in pain, I will talk to them or a family member, and see how they react to the same exam while they're distracted.
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 vs not. For instance, I have this guy who has depression 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 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 nonsense.
Nicole Weymann 12 minutes ago
"supratentorial": duly noted and added to my personal vocabulary.
#22
Pharmacy tech here. You can tell a lot of fakes that go the pharmacy. They'll usually come up happy as clam talking to people in line, but as soon as theyre up to the window they put on their bad feels face. Also a lot of doctors in our area like to pair up pain meds with antibiotics for whatever they say they're ailment is and when then come to pick up at our pharmacy they'll only take the pain med. Our pharmacy dispenses most antibiotics for free.
#23
ER doc here. One thing you quickly learn is that our ability to judge "faking it" is often flawed. Your subjective interpretation of a patients presentation is often disproved by objective investigations. Something may seem obviously faked by one physician, but then when you see the patient you realize that something horrible was missed. Or they find something that you missed because your bias led you to under-investigate, which is a horrible feeling. As such the risk of assuming somebody is faking it is far greater than the risk of working them up properly.
Just off the top of my head a few years ago I had a patient who I thought was faking neurologic symptoms and had seen neurology in the past and didn't have a diagnosis yet. She said the neurologist told her that it "might be psychiatric" but she thought he was wrong. That's always a bit of a flag, especially when someone is looking for a sick note, but I noticed that she hadn't had any imaging done on her brain yet (it was ordered but pending), so I just ordered it in the ER. She had multiple tumors in her brain, presumably metastasized from elsewhere.
The thing that throws a wrench in it, though, is that there are patients who have had numerous negative workups but are looking for disability payments. This becomes difficult to manage (and is much worse if you're a family doctor) and often requires multiple referrals to get cleared up if there is any actual pathology. This can take an extensive period of time, and if the insurer doesn't have an independent physician to assess the patient this can turn into months or years of payments with no ultimate diagnosis.
#24
Classic case is people claiming they've lost their sense of smell (to get insurance money) - easy solution:
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.
Thing is: the "smell" of ammonia isn't perceived through the N. olfactorius (smelling-nerve) but rather through pain induced in the nose (through the N. trigeminus) - 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).
TLDR: Ammonia (or is it ammoniac? English plz.) doesn't smell, it hurts.
#25
As a doctor in acute medicine in the NHS in the UK.
1. The faker will always exaggerate the symptoms and my experience tells me that things adding up. Such as the seizure that is overly violent, that lasts too long, they remain too sleepy afterwards.
2. The lack of anything else wrong with them. Such as the intense pain without raised heart rate, or that you can distract them by talking to them. It is hard to be properly ill with normal blood tests. Hyperventilating to make yourself look unwell shows up with low CO2 and becoming alkalotic with high O2 although nothing else wrong.
3. By talking to the faker the agenda becomes apparent early. For example, wanting pain medication, wanting cyclizine for nausea via the IV rather than oral route, wanting admission overnight. Who in the right mind would want to stay in hospital!
4. By the time I've seen them, just by looking in the medical notes or calling the GP, it'll rapidly become clear they've done it before. Not many people do fake, by they'll probably do it numerous times.
5. Suspicion increased in young women 14-30 yrs, with hard to measure signs such as pain (headache or abdominal) or changes in sensation which we can't measure or examine for.
6. In terms of change in sensation or motor function, due to their lack of neurological understanding they'll have impossible symptoms i.e. out of nerve distribution or not congruent with neuroanatomy.
I tend not to worry too much about fakers. They often get bored quickly and the medical history often show them to be repeat attenders. Who cares if they get a bit of morphine whilst we find this out.
#26
Tell them the only solution is amputation.
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