* * Anonymous Doc: So you're not really a movie star?

Friday, January 6, 2012

So you're not really a movie star?

A patient comes in yesterday, claiming new-onset neurological deficits-- word-finding issues, trouble walking, weakness on one side.

Perfect opportunity to give one of my med students a chance to get a complete patient history.

Which he does, and it's a doozy. Entire family killed in a terrorist attack overseas. Was a movie star in his home country. Long history of medical problems. Long list of allergies. Tons of medications.

A few hours later, urine test comes back positive for drugs.

Claims he never took drugs. Claims someone's tampering with his urine.

Which is when I start to get suspicious. Probably should have gotten suspicious earlier. See, in my zeal to make sure the med students would learn something, sure, I let them take the history... and waited to check the computer for any past notes and discharge summaries.

Nine previous admissions. In each case, claiming a completely different set of symptoms, and giving out a completely different history. In each case, ending up on the psych service, and eloping from the hospital. In each case, nothing actually found to be physically wrong with him, drugs in his system, and, all in all, a hefty waste of taxpayer money.

Called his "emergency contact." Who hasn't seen him for 25 years. And confirmed that he's crazy. No family killed in any terrorist attacks. Not a movie star. And, upon some quick testing, no neurological deficits.

"So, how many patients fake their entire story?" asks the med student.

"Oh, not too many."

"But from now on, I should be skeptical?"

"I guess. I wasn't, at first. But, yeah, I guess we should be."

"And this whole thing wasn't just a test?"

"Uh... if I said it was a test, would it make me look less ridiculous for not realizing it for a day and a half?"


  1. I absolutely love this blog - and I esp like that it's not one-sided and includes a mix of doctor and pt stupidity! The thing is, as a pt myself suffering from a long list of symptoms and diagnoses, many of them that are invisible (such as pain), I don't want future med docs to be skeptical of patients. I am lucky now that I have positive test results to "prove" that I am not crazy and drug-seeking, but in the first couple years, my docs didn't order the right tests and so all my test results were negative. I was seen as some crazy drug seeker when I don't want pain drugs, I just want to get better and to be able to work again. So please please please don't encourage your med students to be skeptical, but to be understanding and open-minded instead, and to understand that sometimes just because nothing is found to be physically wrong with a pt, doesn't mean that is the case. Many things like CRP/RSD or ME or chronic lyme (i know that's controversial) cannot be easily tested. Or maybe the correct tests haven't been ordered and they need to dig a bit deeper. I would rather future docs to understand that most pts are not drug-seeking and they should not be skeptical. I owe my life to docs like that.

  2. Thanks for the perspective, and I'm glad you ended up finding doctors who helped.