Fake it till you make it…… to hospital

20minutes ago she was having ‘seizures’ on the concrete in the alley next to the arts theatre. As I walked past her in the hospital the young woman was uploading a selfie onto facebook.

She was simply another patient who had fallen into the routine pattern I had witnessed many times before already: seize an opportunity to seem sicker than you are (or just as often when you’re not sick at all), milk it for all its worth as people lavish attention and concern on you…. and then stop acting as you detail it to all who will listen via social media when you’re in the back of the ambulance or ED because the healthcare staff have seen it hundreds of time over and won’t be sucked into the charade.

One thing that has surprised me since starting work as a paramedic is the sheer number of people who fake injury/illness. Whether it’s attention seeking behaviours or more disturbing reasons, attending a patient who has minor or no physical injuries who plays the dying swan is a near daily occurrence.

The 18 YO male who punched a fence twice breaking his wrist (a story for another post) who feigned fainting and lay on the floor refusing to open his eyes or sit up (He woke up pretty quickly when we said we were calling him a taxi and he’d be paying the fare).

The 55 YO woman who called us for shortness of breath and was certain she wouldn’t survive the night……. yet was able to yell abuse at her neighbour, call the dog over and without pausing for breath give her sad life story in detail to my partner (a cup of tea was made in there somewhere to).

Or as first mentioned, the teenage girl who faked a seizure, then faked being unconcious following her dance perfomance…… which inspired her younger sister to do the same thing and resulted in 2 emergency ambulances being utilised and unavailable for 2 hrs.

It can be frustrating and depressing. Even more so when it’s in the early hours of the morning on night shift. You recognise the name before you see the face and wonder what they’ve called for this time.

What do you do with these patients? I mean aside from ticking the box to get them out of your care? And how do you prevent yourself from losing it at them, or them taking advantage of you?

Ultimately, you do need to ensure that there are indeed no physical illnesses or injuries present. Is there an electrolyte imbalance? A medication disorder? A new onset condition? There are innumerable causes for altered concious states, and you’d hate to be the person who missed a sub-arachnoid haemorhage because you thought they were wasting your time.

But quite often there are some quick hints and tests you can utilise (like tickling eyelashes of closed eyes to observe for a rapid eye movement or blinking response) or noticing that the seizure looks more like a poor attempt at twerking than tonic-clonic movement (and yes twerking did just make it into my blog).

Secondly though, there is a certain level of sensitivity required. The love, grace and patience demanded of healthcare professionals is required to extend to all our patients. Not just the ones we like.

So whilst we should certainly not empower them or put up with undue rubbish, labelling them as time-wasters and pushing them out the door so that they re-present a week later is not the best solution.

Worse still, is when the required scans, bloods and other tests are conducted simply for legal liability purposes, and yet no one actually assists the pt to recognise the inappropriate nature of their behaviour, let alone diagnose the causes behind it.

The key point is: Opportunities to connect patients to social/psychiatric support services are so often missed because we cannot be bothered. Bothered with the additional time it will take, with staying awake at 2am or with the emotional energy it will require.

Whatever it is for you, you need to find the motivation to treat that patient properly. And by properly I mean find the correct support services to refer them onto, explain how they’re mis-utilising the healthcare system (and the effect that has on others).

They may be so selfish as not to care or change the first couple of times. But if you can over the course of 2-3 years prevent them from ever mis-presenting again, isn’t it worth it?

It’s certainly better than dealing with them for the next 20-30 years.

Your motivation might be remembering that it’s someones kid, sister, mother. It could be forcing yourself for the sake of your professionalism to do things for the best patient outcome. You could be amazing and just genuinely care about every patient. You could like myself, believe from the Christian viewpoint that we have no right to charge these patients, and that God in his never ending love has given us each so many second chances that we should afford this person one too (Matthew 18:21-35)

And who knows, you may help them redeem a little more than you bargained for.

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