Wednesday 15 February 2012

You can't fool me........

"27 year old female, multiple seizures"

Another day, another dollar! We were on a late shift and were busy clock watching, timing our jobs nicely to hopefully be off on time. Unfortunately we got a late one! Couldn't be helped, it was a Red 2 and because of the nature of the 'life threatening' condition she got the ambulance + FRU response. Repeat seizures or status epilepticus is indeed life threatening and can cause permanent brain damage if left untreated. We shot round to the address and arrived at the same time as the FRU. We all piled into the house, met my a friend at the door. Apparently they had been watching TV and she just started seizing and had continued on and off for 15 minutes now. I was first into the living room. She was lying on the floor, surrounded by friends, shaking violently. Foam sputum protruded from the mouth and her eyes were staring blankly at ceiling. Her arms were in a decerebrate position and her toes were pointing downwards. This is normally a sign of severe brain damage. This meant only one thing........She had done her homework. 

She was faking. Admittedly she was doing a very convincing job but the first clue was in the eyes! She was staring and focused. Eyes would normally role to the back of the head. The second was that her movement looked forced and calculated. Then, there was a few little tests. Once I took hold of her wrist her 'decerbrate' flexion relaxed. That wouldn't happen. I then lifted her now limp arm, held it above her face and let go. Sure enough it fell to the side of her face. That wouldn't happen! It would hit her face because an unconscious person would have no way to stop it. A conscious person doesn't want to be hit in the face. Finally she made a miraculous recovery after we'd been there only 2-3 minutes! No post-ictal period or confusion at all. I wasn't impressed. I told her to stop faking it. She tried her best to carry on the lie and when asked what meds she took for her epilepsy she named Zarontin and Haloperidol. Unfortunately Zarontin is only used to treat 'absence' seizures, and not the tonic-clonic ones she claimed she suffered with and we saw her fake! As for Haloperidol, well that's an anti-psychotic used to treat schizophrenia! She didn't have any medication on her as she'd 'run out'! Hmmm......I smell a rat. We took her to hospital because that's what she wanted. She wouldn't admit the truth. She even asked us to do an ECG to check her heart. What a waste of time and money for both the hospital and the ambulance. I gave my handover and the nurse recognised her. She was a known faker, a frequent flier, a sufferer of Munchausen syndrome. Oh, and I was an hour late off!

'Munchausen's syndrome is a psychological and behavioural condition where someone pretends to be ill, or sometimes induces symptoms of illness in themselves. Munchausen's syndrome is also known as factitious disorder.'

The cause of it is largely unknown, mainly because the people with it refuse to accept they have it and therefore refuse any psychiatric treatment meaning very little is known about their motives, thought processes or social and family upbringing. I personally think it is no more than extreme attention seeking and a desperation to be noticed. The symptoms of Munchausen syndrome range from faking psychological symptoms such as hearing voices to pretending to have physical symptoms like chest pain. In extreme cases they will go as far as self harm in an attempt to make them ill enough for a hospital admission. Commonly though they'll complain of things like breathlessness, abdominal pain, chest pain, seizures and black outs because they are easy to fake and hard to disprove. Often they'll claim to have had a combination of many such as a fall, then a seizure, and now chest pain. It isn't uncommon for some minor self harming to occur to show an injury from said fall.

Munchausen syndrome differs from hypochondriacs in that sufferers are aware that they are lying and exaggerating and it is calculated. It is a psychological disorder which requires treatment but one I personally have very little time for. Sufferers can spend years jumping from hospital to hospital wasting resources everywhere they go. They tell similar stories and repeat similar symptoms but unfortunately due to the accuracy in the portrayal of symptoms staff have no choice but to repeat all the costly tests to disprove lies. Due to the nature of their condition they become very manipulative people and will stop at nothing to get the attention they crave. There are documented cases where people have died as a result of complications  arising from unnecessary treatment.

It isn't known how common Munchausen's syndrome is, it's hard to quantify and hard to prove. I suspect a large percentage of the patients I go to are faking it for attention but you never really know. There are two distinct groups of people who appear to be affected. Women who are 20-40 years of age with a background in health care like nursing, caring, even EMS and medical volunteers. This enables them to add detail and medical knowledge to their symptoms to gain credability. The other is unmarried white men between 30 and 50 years of age. It is unclear why this is the case. What I have noticed is that Munchausen syndrome isn't just limited to hospitals and my patients but it is commonplace on social media forums such as Facebook and Twitter. People can manipulate a 'following' to receive a constant stream of sympathy negating the need to actually fake an illness or self harm, behind anonymity. Maybe this is where it starts. In a society where ones life can exists solely on these platforms perhaps faking a seizure in front of friends is the next logical step. All I know, is that when these fantasies, delusions or attention seeking acts spill out into our work load it puts us into a dangerous situation of possibly giving drugs that are not needed putting our jobs in jeopardy. Not to mention the grave cost to the NHS in wasted time and resources. It's selfish behaviour and takes a resource away from where it is actually needed all so someone can get some sympathy and attention. Maybe i'm being harsh, but it really annoys me and is criminal. The medical version of perverting the court of justice.

I'm not sure what the best thing to do is. Personally, when someone is faking, lying or exaggerating I tell them. I'm certainly not going to indulge in their game, nor am I going to let them think it is acceptable. You can only treat people who need & want to be treated. These people need but don't want treatment. All you can do is make it as difficult and unappealing as possible for them to do it. Shout from the rafters and point! 


  1. Very well said! There are indeed some on twitter lie for atention. Its pathetic and the fact they waste police and ambulance and hospital time is sick. No time for these idiots. I hope they read ur blog and are ashamed.

  2. Oh god, she actually does this stuffs. I amazed with her act on multiple seizures. And you did a fantastic job, nice catch - no one cant fool you!!!!


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