Wednesday 14 December 2011

Thou shalt not lie........

"43 year old female, chest pains"

Patients lie. It's a fact of life. They don't necessarily do it on purpose but do it all the same. They will tell you one thing, then tell a doctor something else. They will tell you they are in so much paid when they clearly aren't. They will say the have no allergies when they do. They omit crucial parts of their medical history, like have 2 hearts, 1 lung, blindness or extra kidneys. This particular day was your big standard, non cardiac chest pain, no risk factors, right sided and most likely muscular.

We arrived at the house, it was in a nice road, in a nice area and were greeted by a well dressed, well spoken gentleman. He led us through to his wife who was doing her best impression of a dying swan on the sofa. Writhing about, flannel on head, moans and groans galore. From her history I was confident she wasn't seriously ill, her pain score was 10/10 (it wasn't, this was her first lie) but we have to take what a patients says as possibly true. Admittedly, pain is subjective, nether the less, I know a pain score 10 and this wasn't it. Her pain appears to vanish when she was talking but as soon as she stopped it was back. I asked about any allergies and past medical history. No allergies and no previous chest pain (this was her second and third lie). She said the pain came on whist carrying stuff up stair (fourth lie).  She also added she doesn't take any medication and is normally fit and well (fifth and sixth lie). As it was chest pain, as much as I thought it was a LOB we chaired her to the truck. 

On board, we did the usual battery of tests, sitting / standing blood pressure, ECG, cardio assessment, thorough history etc. All was fine, except her pain was worse. She started using buzz words like central and crushing, feeling clammy. *sigh! She wasn't, I knew it, my crew mate knew it and so did her husband. I got the impression she was a huge hypercondriac. Anyway, as I couldn't prove she was lying, so I treated as per guidelines. GTN, Aspirin, Morphine etc. Now the second, fifth and sixth lie became apparent. She DID have allergies. She was allergic to aspirin. It also transpired she was on gastro-restraint tablets due to a stomach ulcer so to say she was on no medication and was normally fit and well was simply not true. Anyway, I gave her the GTN, popped a line in to give some morphine. I flushed the cannula through with 10mg of saline flush. Within about 5 seconds she said:

"Wow, that stuff is amazing, the pain is almost completely gone" (and there is the first lie, 10/10 my arse)

"Really?! What's your pain score now?"


"Excellent, we'll head off to hospital now"

It appears the placebo effect of saline was the miracle cure she needed. Ok, to be fair, she thought she was getting morphine, and she was going to, but the placebo effect did wonders so I didn't tell her the truth until we were at hospital. If they can lie so can I.  Not totally ethical but totally necessary! We trundled off to hospital with our 'cured' patient. We took her into A & E and were greeted by a nurse.

"Hello Jane, back again?!" (me and my crew mate exchanged a look)

"Yes, my chest pain came back again" (Again? and there is the third lie)

"Did it come on while resting again?!" 

"Yes, I was just watching TV" (And there is the fourth)

Apparently Jane has been to A & E 5 times this week. Same complaint. Same discharge summary. Nothing found. This information would have been useful prior to carrying her and treating as a new chest pain. In the 40 minutes with her she told six lies. This isn't uncommon. You learn to take what patients say with a pinch of salt (within reason) and like a episode of CSI, piece together what is actually going from various peoples different stories and their observations. 

I wish there was a way to stop the lies but there isn't. Everyone does it, myself included, however, if you are going to call an ambulance you should expect to be questioned about your medical history. These questions aren't because we are being nosey, it's because a full medical history has a massive baring on diagnosis and treatment. Lie to us, and we pass your lies onto the hospital, and before you know it your symptoms are worse because you've not told us about medication you're on or allergies you have. So, in the words of the lord almighty, "You shall not bear false witness against your neighbour.” Exodus 20:16. In other words don't lie you muppet.

1 comment:

  1. I really wish we had a database of frequent flyers and general pests that we could refer to instead of just learning about them through experience.


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