Malingering

(Through Rose-Coloured Glasses)

According to Wikipedia, “Malingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of “secondary gain” motives, which may include financial compensation (often tied to fraud); avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences; or simply to attract attention or sympathy.”

This is a very common and widespread phenomenon, from the much jokingly used “I have a headache”, to a hoax as in “Ferris Bueller’s Day Off”, to the disgusting cancer fakers.

The medical community is full of such tales.

While in medical school, a professor told us this: A man came into the emergency department, complaining of back pain. He walked with a significant limp; his back bent and was in constant pain. Examination and X-ray showed nothing. He was diagnosed as malingering, and sent on his way. To be sure, our good-hearted doctor followed him out of the hospital, and observed. For a few blocks, he was still limping, dragging his leg. Our professor was almost ready to call him back to the hospital, when suddenly, he straightened up his back and marched quickly onward and disappeared into the night.

On another occasion, while interning, an old man was admitted to hospital for investigation, complained of general weakness. To our amazement he used his hospital bed as a hotel room, disappeared in the day time and showed up only at night, came and went as he wished. When he was in, he was constantly on the phone, conducting his business. We were ready to discharge him, but by then, we discovered that he really had a medical problem, a type of slow progressing blood cancer. As soon as we broke the news to him, he was quite indignant and immediately signed himself out of the hospital. When malingering became a real condition, he refused to accept and face the consequences.

And then there were those infamous patients, who were frequent visitors to the emergency departments around town, carrying with them letters from doctors stating that they have certain chronic disease that required pain medications. As soon as they arrived, we usually heard about the warnings throughout the department right away, and be on our guard.

Occasionally we have the professional patient who seemed to know the medical textbooks thoroughly, and can fool any well-knowledge doctor; they proudly displayed their surgical scars to prove their tales, but obviously with no actual findings. They are the un-avoidable Munchhausen’s. It is a disturbing psychological disease. Most of them refused proper psychiatric treatment when confronted.

And then every day in their office, physician faced the many drug addicts, seeking pain-killers and other prescribed drugs. They invented stories and believable clinical histories and symptoms, just to get a prescription to satisfy their habit. Early in my practice, there was this Dutch ophthalmologist, daughter of a patient of mine, who was visiting from Holland. She gave a history of certain cancer that led to a bone fracture of her back while horseback riding. I referred her to a specialist, really concern about the seriousness of her illness. A few weeks later, I received the consultation report; the specialist found no signs or symptoms of any cancer but discovered the lady was addicted to drugs. Contrary to her advice, the father remained my patient for years.

A warning to those cancer fakers, eventually when the real wolf strikes, by then, no matter how loud you cried wolf, nobody will believe you, and you will be left all alone in this world, a pathetic tragedy of your own making.

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