We had a lecture last week about two things we need to watch out for in the clinic: drug-seekers and malingerers. Today, my first malingerer. A 29-year-old guy who wanted me to sign his disability forms because he hurt his shoulder. "I can't lift it," he said. And then he lifted it. "It only hurts sometimes, but when it hurts it really hurts. I can't work at all." How do you spend your day, I asked. "I walk around a lot, helped a friend move the other day." You helped a friend move? "Yeah, yeah, I was feeling okay that day." Surely if you're able to do that, there's some job you could get, I said. "Not really."
I'm almost offended he didn't try a little harder to sell his story. At least make me wonder if you're telling the truth, at least put on a little show for me. But, no, his friends probably told him the doctors don't even care, they sign the forms, doesn't matter what you say. Problem is, even if I don't sign the forms, he'll just go to doctor after doctor until he finds one who will. The Internet says so. You google for information on this stuff and there's websites that say if your doctor doesn't believe you, "consider finding a more compassionate doctor."
This guy was a ridiculous example, but, honestly, I think if someone really wanted to fool someone like me, it wouldn't be that hard. I'm still questioning most of my own judgments, the last thing I want to do is accuse a patient of being a liar and not giving him the treatment he might need. I don't walk into the exam room assuming the patient is lying-- I don't think any of us do. We assume our patients come to see us because they're sick, and they need our help. We have to trust. So many conditions can present in so many different ways, and often enough the first guess is the wrong guess and we have to dig deeper. Patients with real symptoms sometimes have normal test results. We don't always know what we're doing. To add in a layer of suspicion-- to make us question the honesty of every patient-- I don't think it's something most of us do naturally.
I didn't sign the forms. I went to the resident in charge and she talked to him and agreed with me. He didn't even seem annoyed by it-- I'm guessing we weren't his first stop. And we won't be his last. And he'll find a doctor who'll either look the other way or he'll improve his story until he can fool someone. Of course, with the energy he's spending trying to get on disability, he could probably just get a job.