Can a doctor tell...

[maggiefke]

Quick question: is there a way for a doctor to tell whether a patient - who claims that he has stomach flu, saying he's been throwing up everything he eats and having diarrhea - is telling the truth or not? In other words, is it possible for the doctor to be able to disprove and know that the patient is not sick if he's faking it?

 

Thanks

[mrnursing]

Well... let's see.

 

You have diarrhea and have been vomiting.

 

You lose fluid (hypovolemia), and you lose bicarbs. Your heart rate will increase to increase the cardiac ouput to sustain BP.

 

Due to the loss of bicarb, your body will try to compensate for the acidosis by breathing faster. Your respiration may be shallow.

 

I would probably auscultate and palpate your abdomen to see if you have a major problem.

 

I would also listen for hyperactivity and the pattern.

 

I'm sure that experienced physicians can tell up to some extent.

 

Welcome to premed101.

[dreamer87]

Quick question: is there a way for a doctor to tell whether a patient - who claims that he has stomach flu, saying he's been throwing up everything he eats and having diarrhea - is telling the truth or not? In other words, is it possible for the doctor to be able to disprove and know that the patient is not sick if he's faking it?

 

Thanks

 

lol

 

i hope this isn't so you can get a fake note

 

and yes its possible. for example, if the doctor asks you something simple like "when did you throw up - how long after eating" - if you say like 6-7 hours, that is not food poisoning. you usually start throwing up 3 hours after ingesting contaminated food products. so yeah, they can tell if you're faking it!

[maggiefke]

lol. food poisoning and stomach flu (gastroenteritis) is different though, right?. If he says he's been having a mild upset stomach for a few days (the "incubation period") and started throwing up that morning, isn't it quite realistic? Also, for the losing fluids thing, the patient can say he's been drinking a lot of fluid and has been replenishing electrolytes. So it's not that hard to fake sick... i think..

 

thanks for your replies!

[dreamer87]

lol. food poisoning and stomach flu (gastroenteritis) is different though, right?. If he says he's been having a mild upset stomach for a few days (the "incubation period") and started throwing up that morning, isn't it quite realistic? Also, for the losing fluids thing, the patient can say he's been drinking a lot of fluid and has been replenishing electrolytes. So it's not that hard to fake sick... i think..

 

thanks for your replies!

 

well, food poisoning is one of the potential causes for gastro-enteritis - food poisoning meaning ingestion of contaminated food/drink. you are thinking about viral gastro-enteritis (since you are talking about incubation periods). viral gastro-enteritis can be transmitted through contaminated food.

 

and yes it's not hard to fake it. but doctors can tell when you're BSing anyways. for example, i work at a doctor's office and my boss and i always laugh when people come in all dressed up, perfect make-up, perfume, heels and i have to type up notes saying "they are extremely sick, have had diarrhea 6X + nausea and vomiting and are too weak to write a test" while they yap on the phone with their girlfriends and work on looking pretty - yeah you don't dress up that much when you're spending half the day in the loo. just sayin'.

[Ollie]

Even if I had my suspicions that someone was faking a gastro to get out of school/work, I wouldn't bother to look in to it unless it was a recurring theme.

[ploughboy]

Quick question: is there a way for a doctor to tell whether a patient - who claims that he has stomach flu, saying he's been throwing up everything he eats and having diarrhea - is telling the truth or not? In other words, is it possible for the doctor to be able to disprove and know that the patient is not sick if he's faking it?

 

Thanks

 

You would be amazed (amazed!) by the number of young, previously healthy students who show up in emergency departments and family docs offices with mystery ailments around exam time.

 

They often tend to over-embroider their stories, which can actually be counter-productive. I'd prefer to have a patient level with me and say "look doc, I've got this exam tomorrow and need a note", rather than endorsing symptoms which will compel me to actually investigate him/her further. It's less of a waste of time for everybody involved.

 

pb

 

PS: study harder next time

[doctulk]

Quick question: is there a way for a doctor to tell whether a patient - who claims that he has stomach flu, saying he's been throwing up everything he eats and having diarrhea - is telling the truth or not? In other words, is it possible for the doctor to be able to disprove and know that the patient is not sick if he's faking it?

 

Thanks

 

For the most part, people who are that miserable, look that miserable - pale, sunken eyes, diaphoretic, etc, etc (see mrnursing's comments). If someone came in to see me complaining of those symptoms but looked like they just stepped out of GQ magazine or something, I'd be suspicious. But, given the fact that they could be on the tail end of something viral and could still be shedding the virus, I would probably give him the benefit of the doubt to ensure that the infection is contained.

 

We are getting over a dose of Norwalk here in my community and infection containment is paramount. The hospital is the worst place you can go if you have symptoms such as these unless of course you are an infant, elderly, immunocompromised or severely dehydrated.

 

Stay home, get some rest, practice good hygeine and replace electrolytes.

 

And as someone previously said, study harder.

[FMX]

I'd prefer to have a patient level with me and say "look doc, I've got this exam tomorrow and need a note", rather than endorsing symptoms which will compel me to actually investigate him/her further. It's less of a waste of time for everybody involved.

 

not to mention $$ and resources...

[HBP]

Dr. House can.

 

And this Dr. could...

 

http://www.redflagdeals.com/forums/can-i-file-complaint-against-doctor-being-rude-875127/

[apache]

I would go with horrible migraine. That ones a little harder to disprove. Just wiki it and give a description and whos to say youre not experiencing one, not like theyre going to rush you in for an eeg LOL

[apache]

meh, yeah, if someone just told me they were anxious because of their exams id be pretty chill about it too...

 

You would be amazed (amazed!) by the number of young, previously healthy students who show up in emergency departments and family docs offices with mystery ailments around exam time.

 

They often tend to over-embroider their stories, which can actually be counter-productive. I'd prefer to have a patient level with me and say "look doc, I've got this exam tomorrow and need a note", rather than endorsing symptoms which will compel me to actually investigate him/her further. It's less of a waste of time for everybody involved.

 

pb

 

PS: study harder next time

[Noodle]

You would be amazed (amazed!) by the number of young, previously healthy students who show up in emergency departments and family docs offices with mystery ailments around exam time.

 

They often tend to over-embroider their stories, which can actually be counter-productive. I'd prefer to have a patient level with me and say "look doc, I've got this exam tomorrow and need a note", rather than endorsing symptoms which will compel me to actually investigate him/her further. It's less of a waste of time for everybody involved.

 

pb

 

PS: study harder next time

 

I did this only once in undergrad in my last week of studies. And I will not do it again because the (made up) symptoms I mentioned to my doctors had them so worried that I was pregnant or with an STD that they did a gynecolocial (sp?) exam. Once the exam was underway (and they could see that what I was saying was not true), all I could think was "I am so busted!". The doctor ended up writing me a doctor's note, but I was totally embarassed because we both knew that it was a sham.

 

If I had known that I'd have to a) pull down my pants for the doctor to investigate and then look like a total fool, I would have totally done that 5% presentation and skipped seeing the doctor. Older me now knows better.

[supafield]

Dr. House can.

 

And this Dr. could...

 

http://www.redflagdeals.com/forums/can-i-file-complaint-against-doctor-being-rude-875127/

 

Hilarious thread!

[JeraJaclyn]

I think there are quite a few symptoms that are reasonably easy to fake (eg. back pain, nausea, head ache). It is important for doctors to not be too suspicious of a patient's trustworthiness. I would rather treat 10 people that didn't actually need treatment than miss one that did. There are many people who have had bad experiences with doctors not believing them about pain and it leads to a distrust in the medical profession.

 

Of course if there is a pattern that you notice (such as being "ill" at every exam period) or you think someone might be abusing or selling their medications you have much more of a reason to be suspicious.

[The Law]

I did this only once in undergrad in my last week of studies. And I will not do it again because the (made up) symptoms I mentioned to my doctors had them so worried that I was pregnant or with an STD that they did a gynecolocial (sp?) exam. Once the exam was underway (and they could see that what I was saying was not true), all I could think was "I am so busted!". The doctor ended up writing me a doctor's note, but I was totally embarassed because we both knew that it was a sham.

 

If I had known that I'd have to a) pull down my pants for the doctor to investigate and then look like a total fool, I would have totally done that 5% presentation and skipped seeing the doctor. Older me now knows better.

 

LOL. Quite the symptoms you must have come up with.

[Noodle]

LOL. Quite the symptoms you must have come up with.

 

This is what happened....

 

I knew that sometimes it took ages to get in to see the drop in doctor (I once waited 4 hours in the McGill health clinic for a perscription)...so, I decided that I would add vomiting (as a fake symptom) to the list of other fake symptoms in order to be seen sooner. "Vomiting" sure got me seen sooner and then I was questioned by three concerned doctors and then examined....such a bad experience. and it took forever and was humiliating. But I guess that's karma for you!

[Noodle]

moving on.....

[nemesis]

I did this only once in undergrad in my last week of studies. And I will not do it again because the (made up) symptoms I mentioned to my doctors had them so worried that I was pregnant or with an STD that they did a gynecolocial (sp?) exam. Once the exam was underway (and they could see that what I was saying was not true), all I could think was "I am so busted!". The doctor ended up writing me a doctor's note, but I was totally embarassed because we both knew that it was a sham.

 

If I had known that I'd have to a) pull down my pants for the doctor to investigate and then look like a total fool, I would have totally done that 5% presentation and skipped seeing the doctor. Older me now knows better.

 

This is what happened....

 

I knew that sometimes it took ages to get in to see the drop in doctor (I once waited 4 hours in the McGill health clinic for a perscription)...so, I decided that I would add vomiting (as a fake symptom) to the list of other fake symptoms in order to be seen sooner. "Vomiting" sure got me seen sooner and then I was questioned by three concerned doctors and then examined....such a bad experience. and it took forever and was humiliating. But I guess that's karma for you!

 

WoW!

 

Sorry to say, but you probably deserved that humiliation...it taught you a valuable lesson!

[Madz25]

I would go with horrible migraine. That ones a little harder to disprove. Just wiki it and give a description and whos to say youre not experiencing one, not like theyre going to rush you in for an eeg LOL

 

not an EEG but they might do a CT of your brain to rule out anything scary. thats what your young brain needs...a nice dose of unnecessary radiation.

 

I did this only once in undergrad in my last week of studies. And I will not do it again because the (made up) symptoms I mentioned to my doctors had them so worried that I was pregnant or with an STD that they did a gynecolocial (sp?) exam. Once the exam was underway (and they could see that what I was saying was not true), all I could think was "I am so busted!". The doctor ended up writing me a doctor's note, but I was totally embarassed because we both knew that it was a sham.

 

If I had known that I'd have to a) pull down my pants for the doctor to investigate and then look like a total fool, I would have totally done that 5% presentation and skipped seeing the doctor. Older me now knows better.

 

LMAO!!!!!!!!!!

too funny

[UTPEOPLE]

I did this only once in undergrad in my last week of studies. And I will not do it again because the (made up) symptoms I mentioned to my doctors had them so worried that I was pregnant or with an STD that they did a gynecolocial (sp?) exam. Once the exam was underway (and they could see that what I was saying was not true), all I could think was "I am so busted!". The doctor ended up writing me a doctor's note, but I was totally embarassed because we both knew that it was a sham.

 

If I had known that I'd have to a) pull down my pants for the doctor to investigate and then look like a total fool, I would have totally done that 5% presentation and skipped seeing the doctor. Older me now knows better.

 

wait... you're a girl too? gosh... i'm really bad at telling genders apart on forums...

[Noodle]

I did this only once in undergrad in my last week of studies. And I will not do it again because the (made up) symptoms I mentioned to my doctors had them so worried that I was pregnant or with an STD that they did a gynecolocial (sp?) exam. Once the exam was underway (and they could see that what I was saying was not true), all I could think was "I am so busted!". The doctor ended up writing me a doctor's note, but I was totally embarassed because we both knew that it was a sham.

 

 

ack! I can't even spell gynecological! today has been a rough premed posting day!

[ploughboy]

I would rather treat 10 people that didn't actually need treatment than miss one that did.

 

Problem being, of course, that not all investigations and treatments are 100% benign. Madz mentioned one upthread. (See also "number needed to treat" and "number needed to kill")

 

To expand on her example and go off on a little rant of my own...my threshold for head CTs in the young is very high, so a malingerer would have to have a pretty dramatic story to get me to scan them in the absence of objective findings. However there are good, experienced emerg docs who have lower thresholds and would scan people that I wouldn't. So depending on the doc you see and the story you tell him/her about your headache, you might wind up getting an unnecessary CT. It's a waste of time, a waste of money, while the test is being arranged the patient is blocking a bed for somebody who actually needs it, and it's an exposure to unnecessary radiation (on an individual level a one-off CT doesn't make a huge difference, but on a population level it does).

 

That's why, although I trust my patients to some degree, I have a high index of suspicion about secondary gain in certain situations. That's also why I really like it when my patients level with me about their true motivation.

[ploughboy]

If I had known that I'd have to a) pull down my pants for the doctor to investigate and then look like a total fool, I would have totally done that 5% presentation and skipped seeing the doctor. Older me now knows better.

 

I'm glad you learned your lesson, young lady...

[Noodle]

Oh, I sure did!