Where’s Qadgop or any of the other physicians on this board?
The behavior Rivkah describes is definitely VERY common in diabetics, and teenagers with Type 1 diabetes are especially notorious for doing this. They often hold their families hostage with their antics; every hospital I’ve ever worked at had a few young people who almost needed their own designated ICU bay because they spent so much time there. I know of a psychologist who specializes in treating deliberately noncompliant diabetics (now, there’s an exercise in futility if there ever was one! :smack:).
I also encountered a teenager who would make herself have an asthma attack if she didn’t get her way, and have heard that this phenomenon is also extremely common in hemophiliacs.
As a new, naive intern, I had a grand rounds patient in grave condition with enterobacter septic shock. It didn’t take long till we figured out he was using his insulin syringes to inject himself with his own feces—in the hospital! Munchhausen was just one of his many diagnoses.
Non-compliance, willfully wrongful-compliance, totally wacked-out compliance…no matter; if it’s willfully fraudulent for gain, it’s malingering; if it’s *not *willfully fraudulent, but instead a psychological, pathological plea for attention—it’s factitious disorder, or Munchhausen.
In my 30+ years as a practicing pharmacist/physician/surgeon I’ve seen a lot more malingerers (i.e. Workman’s Comp…) than Munchhausen patients, but neither are rare. Unless you are an idiot doctor (they’re not rare, either!), you quickly learn how to identify the malingerers (“gee doc, I’m allergic to NSAIDS, Oxycontin is the only thing that gives me relieve!”.…”Uh huh, how about if we try physical therapy instead of narcotics, for your own good?”) 9 times out of 10, you ain’t gonna see that patient again. In fact he probably dropped the PT referral on the floor as he left (and good riddance).
I had a friend who was taking Prozac, which does not mix with dextromethorphan. She ended up in the ER on a bad trip after a PA told her off-handedly to buy some Delsym if her strep throat developed into a cough.
After that, she had to ask doctors for codeine as a cough suppressant. Tessalon wasn’t available as a generic, and her insurance wouldn’t pay for it. She would agree to let the doctor call the insurance company to verify that, and then they’d give her the codeine. They had to give her something like Tylenol 3, because cough syrups were usually dextromethorphan and codeine mixed. I think Tessalon is available in generic now, and she can just pay for it, or maybe her insurance cover it now. But it was something like $120 without insurance.
It wasn’t like she got coughs that often, but she had allergies, and got a lot of sinus infections that led to bronchitis, so for like ten years, she had to go through this every nine months or so.
Ital added. Rivkah (OP), the focus on meaning in OP and thread is as usual sharp as a tack, which makes me wonder–any particular reason you threw “iatrogenic” into the mix?
I’ve never seen it used as anything but hospital- or medical-professional harm.
Which of course would be correct if a medical professional were displaying psychosomatic, hypochondriacal, or malingering behavior or symptoms of Munchaisen’s…
So a “malingerer” isn’t only (as I’d understood so far) someone who exaggerates or diminishes their reactions based on audience and expected results, but also someone who will purposefully make their real physical condition better or worse in order to obtain the desired results? What RivkahChaya is asking about is the second one, I think.
An example of the first would be applying makeup with extra care in a visit to the doctor so you look healthier. An example of the second would be not taking your painkillers when you want to get a stronger prescription, or taking extra in order again to look healthier.
This article lists a lack of compliance as a sign of malingering, if that helps.
From what I’ve read, the definition of malingering varies, and it usually includes faking or exaggerating symptoms. It usually doesn’t mean causing real symptoms intentionally, or allowing symptoms to occur through neglect. But malingering is the only term I can find for defrauding the medical system for a tangible benefit. I wonder if it’s just rare for a person to do it?
Also, I wonder if it could be proven that someone intentionally allowed themselves to have worsening symptoms to take advantage could actually be charged with fraud. Even if they admitted to doing it on purpose and not because they forgot. Can you be forced to take your medicine?
I’m also wondering if there is an assumption that anyone who causes actual self-harm (rather than faking it) must have a condition, because it is so abnormal that even doing it for financial gain isn’t rational. And in this specific case, the mother may be suffering from anxiety or depression at the thought of having to care for her kids during a school break which pushes her to self-harm to avoid the responsibility. In that case, it may not really be malingering anymore.
And if she said “I need help,” that would have been great. Instead, her default was always to be manipulative. I think people would have had more patience with her if she’d been honest, but her lying and machinations were exhausting.
Yes, she needed help, but she never asked for it. She defrauded it out of people and never said “Thank you.”
My experience–as a patient in a mental hospital–is no, in the absence of immediate danger to self or others.
A ring of nurses, aides, and a shrink would not persuade this wild-eyed guy to take his meds once; wild-eyed or whatever, they backed off to go get a judge-order, to which the patient has x days to challenge.
Not that I’m defending her, because I have the same viewpoint that you do, that she’s abusing her illness. But it’s possible that asking for help is part of her anxiety.
Even if she isn’t open to a charge of fraud, I’d think that if caring for her kids is so traumatic that she’d rather risk her own health to avoid it, then by her actions she’ll also risk losing custody of her kids. I could see that as a consequence if this is what’s happening.
Yeah well, if it was only that… but if she only tells the truth in a stopped-clock kind of fashion, it makes her children and anybody close to her very miserable.
Making yourself ill (or *more ill) for little more than attention is the modus operandi of those afflicted with Munchhausen syndrome. But, in my experience, malingerers will also often aggravate their pathology or even sabotage their treatment or post-op plans if the rewards outweigh the risks in their minds. *
Malingerers typically won’t go to the extremes Munchhausen patients are willing to go (i.e. they won’t risk their life). To some, delayed healing in exchange for a few extra weeks off from work is worth it. If they can parlay that into a malpractice suit, too–even better! I consider myself lucky to have gone my entire career without one malpractice suit filed against me. I attribute that in part due to my not suffering fools, or malingerers.
“Secondary gain” is exactly what I was thinking of as well. We see this in workers’ comp sometimes - the injured worker gets a “secondary” benefit (such as attention from family members, being waited on, being pitied, being excused from actually working, etc., and they like it) and milks their injury for all it’s worth. Some may not even be aware they’re doing this, or doing it deliberately. (I worked on the “defense/insurance company” side of worker’s comp as a legal secretary.)
