My Quora Answer to:
What is the most obvious case of a patient 'faking it' that you have ever seen?
One of my favorite stories.
I worked 20+ years in ER's across Wisconsin, from Lake Geneva & Walworth in the the southern part of the state, all the way up to Superior (they'd fly me to Duluth), to Racine, Kenosha, and Milwaukee in the east, to LaCrosse in the west. Unfortunately for this woman, a week before she tried to fool me in Oshkosh, and started the same routine a week later in Hartford.
Her cover story was severe dental pain. She didn't recognize me, so she didn't know I could see right through it. Dental pain is a tough one because crappy looking dentition doesn't necessarily mean there is any pain. Conversely, the most benign looking teeth can be a source of severe pain.
She did have crappy dentition. “I broke a tooth last week and my dentist can't see me until next week.” As an aside, most will see emergent cases like fractures and tooth avulsions. “I can't wait til then and I need pain meds now.” That was my first red flag because she said the same thing exactly a week before.
She begins to cry. “The only thing that works is oxycontin.” 2nd flag.
“Ok, let's try Toradol first.” “I'm allergic to it. #3. “Really? What happens?” “I pass out.” #3 1/2, since syncope can result from allergic reactions but we normally see other reactions first like rashes, difficulty breathing and swallowing, and panic. So she only gets 1/2 a point for that one.
In Hartford I get inspired. “We have a new long-acting anesthetic. The problem is that it takes awhile to work. So I'll numb it up first with lidocaine. You should get immediate and then about 24 hours of relief. Come back then and I'll leave a note to the physicians replacing me to do the same thing. In the meantime, I'll have a hospital employee help get you into a dentist sooner.”
She didn't think things would go like that, so she agreed, I did the injections, and we waited. And waited. “That didn't help. Can I please have something stronger?” Red flag #4. “No. But I will send you home with enough Tylenol to get you through.” She left in anger.
An hour later we get a call from the West Bend ER. “Did so-and-so check in there?” Apparently, she would make circuits of smaller ER's around the state. The major hospitals in Milwaukee refused to see her so she spread her wings and flew.
I always said that sometimes I should give in and prescribe their narcotic of choice, like an Oscar for great acting. But no. I always held the higher ground.
