Land of the Fakers

[whit72]

removed

[bassnmedic]

You know, I have never understood why some medics and EMTS believe that it is their job to play judge and jury and mistreat patients because they fake seizures or whatever...ie..14 gauge INTS or Iv's etc.......Last time I looked and yes it has been close to 20 years, but I believe my oath said "do no harm". That kind of treatment borders abuse.

[fiznat]

^^ I donno about you, but I sure didnt take any kind of oath before I started working EMS.

You're right though, its probably "mean" and perhaps even abusive- but the fact of the matter is that the "faking" patient is also abusing our system. The way I look at it is, every minute that an ambulance crew/firefighter/police officer/ED staffer spends on the baseless complaints of a faker, another patient who truly needs the attention - goes without it. If we get a little more aggressive with our care in a small effort to discourage this kind of faking, I say the ends justify the means.

The tricky part, of course, is deciding exactly who is completely faking and who is a legitimate patient. Best to err on the side of caution here, of course.

[bassnmedic]

^^ I donno about you, but I sure didnt take any kind of oath before I started working EMS.

You're right though, its probably "mean" and perhaps even abusive- but the fact of the matter is that the "faking" patient is also abusing our system. The way I look at it is, every minute that an ambulance crew/firefighter/police officer/ED staffer spends on the baseless complaints of a faker, another patient who truly needs the attention - goes without it. If we get a little more aggressive with our care in a small effort to discourage this kind of faking, I say the ends justify the means.

The tricky part, of course, is deciding exactly who is completely faking and who is a legitimate patient. Best to err on the side of caution here, of course.

Maybe educating the public in a manner other than TV shows like Rescue 911 would alleviate some the system abuse. But according to you 2 wrongs make a right or did I take that wrong?

[fiznat]

But according to you 2 wrongs make a right or did I take that wrong?

No, you took it the way I meant it. It sounds harsh and cold, but you know - EMS is too busy to be all nice and cuddly with every single person we come in contact with. If someone is maliciously abusing the system then as far as I'm concerned- they get what they deserve. I'm not saying we should go out and perform some sort of half-ass vigilante medicine, but I dont see why we shouldnt use a slightly larger bore IV or an uncomfortable KED to gently discourage those who would otherwise further burden our already stressed systems with fake complaints.

Maybe I'm a little too cynical, but fake patients kinda get to me. Sure, there are plenty of good reasons to call 911 - even if you dont have a huge medical complaint and would like to talk to a counselor or something. Sure, no problem. ...But people who claim kneck/back pain just so they can sue, or patients who abuse 911 in order to get a ride across town re3ally start to grate on ya after a while...

Once again I have to add the caveat that we dont always know what is fake and what is not fake-- so in 99.999% of the time it is of course best to assume the patient's complaints are legitimate.

[bassnmedic]

I can respect your opinion on this, however it has been my experience that providing that kind of treatment/deterrant does not really work as far as the frequent fliers quitting the abuse of the system. Most of them know how the system works and they work it no matter what we say or do. I just don't think it is our job to punish them for their lack of education or their plethora of stupidity.

[hammerpcp]

Working downtown here, your job becomes more of a bullsh it detector then a medical one. They still get one by me every now and then though and I have to say, it infuriates me. And yes, it is our job to weed out the "fakers". It's all part of giving appropriate care for the presenting condition and not wasting resources where they are unnecessary. The really good malingerers will actually cause legitimate health problems in themselves (like injecting feces for example).

[Jess]

I've seen so many sides to this topic and its really interesting. But when someone posted the link to the definition of Munchhausen's it opened up my eyes some. A lot of the people that fake illness or injury and call for EMS personnel, they really truly do have a real illness. I feel now that even if someone is faking, they are sick and need our help and some mental help as well. Although there isn't much we can do for them except transport and talk to them and assist in getting the help they truly need. I admit i wouldn't stick them with the biggest IV there is because I believe they should be treated like a human but then again i also believe that the abuse of the system as to stop. Faking a seizure or faking a syncope episode is a sickness in itself. But if you all get the chance, click the link to the Munchhausen's definition and it will give you a lot of info and background on why people do some of the things they do. Its not an excuse for their behavior but merely a cry for help. Everyone keep posting your ideas, opinions and stories and hopefully we can all do something in time to help these people. That's what we get paid to do. You all take care and be safe out there! Please feel free to comment on what I've said! :hello2:

[hammerpcp]

I've seen so many sides to this topic and its really interesting. But when someone posted the link to the definition of Munchhausen's it opened up my eyes some. A lot of the people that fake illness or injury and call for EMS personnel, they really truly do have a real illness. I feel now that even if someone is faking, they are sick and need our help and some mental help as well. Although there isn't much we can do for them except transport and talk to them and assist in getting the help they truly need. I admit i wouldn't stick them with the biggest IV there is because I believe they should be treated like a human but then again i also believe that the abuse of the system as to stop. Faking a seizure or faking a syncope episode is a sickness in itself. But if you all get the chance, click the link to the Munchhausen's definition and it will give you a lot of info and background on why people do some of the things they do. Its not an excuse for their behavior but merely a cry for help. Everyone keep posting your ideas, opinions and stories and hopefully we can all do something in time to help these people. That's what we get paid to do. You all take care and be safe out there! Please feel free to comment on what I've said! :hello2:

I'm glad to hear you've learned something. How do you feel about Munchausen's by proxy? Should we be sympathetic?

[Jess]

To Answer your question Hammer "should we be sympathetic about Munchausen's by proxy"

Thats a very sticky situation because now we have more than one person involved. But i found this article and I think it would be useful in this discussion.

"In 1977, Englishman Roy Meadow published the first report of a new form of child abuse. He coined the term Munchausen syndrome by proxy (MSBP) after the syndrome that first had been reported by Asher in 1951. This term is applied when an adult, usually the mother, presents a false history to the physician regarding a child who is not suffering from any of the fabricated symptoms. This history causes the physician to perform unnecessary diagnostic procedures that do not result in any specific diagnosis. MSBP has been called Polle syndrome, named after Baron von Munchausen's only child. In 2002, a new terminology, pediatric condition falsification (PCF), was suggested by the American Professional Society on the Abuse by Children (APSAC).

Today, many reports of such cases are in the literature. Some mothers invent symptoms, and others induce symptoms (eg, using ipecac to induce vomiting, overdosing a child with medication, lacerating the urethra to produce hematuria). Fabricated symptoms are not observed by anyone other than the mother.

In 1995, the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) included a definition for factitious disorder by proxy, which is now the accepted psychiatric category for MSBP. The definition includes the following:

Intentional production or feigning of physical or psychological signs or symptoms in another person who is under the individual's care.

The motivation for the perpetrator's behavior is to assume the sick role by proxy.

External incentives for the behavior, such as economic gain, avoiding legal responsibility, or improving physical well-being, are absent.

For excellent patient education resources, visit eMedicine's Children's Health Center and Mental Health and Behavior Center. Also, see eMedicine's patient education articles Child Abuse and Munchausen Syndrome." http://www.emedicine.com/emerg/topic830.htm

I would be sympathetic towards the victim of this and go along with it only because In some cases the parent or caregiver causes actual harm to the victim like giving the child an OD of drugs or doing the things like what as listed above. In the Field, it's hard to determine in some cases what is real and what is not. (eg, using ipecac to induce vomiting, overdosing a child with medication, lacerating the urethra to produce hematuria) I mean those things we wouldn't be able to determine in the field if is the result of munchausens or not unless there was physical evidence (like a empty bottle of ipecac found nearby) but in some cases it can be seen. Its just a tough decision on what to be sympathetic with and what not to be because a lot of times you just never know what is real and what isn't. I've truely learned alot about this disease just from everything everyone has contributed on here! I personally know a victim of Munchausens by proxy. She is still suffering even after numerous reports made by me and other people. Its just sad. Anyways if anyone else has any input on this topic, please share. I like to suck up a lot of info if i can. I'm looking into taking a lot of psych classes because the human mind fascinates me in so many ways. Take care everyone and keep posting!

SJ