Faking It (The Scoop)
added by geena on September 8, 2004 at 9:57 PM
In response to "John's" comment to my last post, Azygos wrote a long ditty that he wanted to get my approval on before posting in the comments. I decided that it was so good that I'd just post it here on the main page.
First of all, John's comment:
Do you guys just assume patients are faking things or is their some criteria for it? I ask this because about 25 years ago when I was early 20s, after having chest pains that took my breathe away for a day and a half I finally went to the ER....
First they assumed it was gastro related and gave me some kind of drink, didn't help and I actually think it made them mad at me when I said it didn't help...They were very hesitant to check out my heart because of my young age, thin build, in good shape, etc...
The nurse was standing at the door to my room when another nurse asked her "what they had going on in that room." I was looking directly at the nurse when she using her index finger tapped herself on the side of her forehead, indicating I was a crazy person...
I got so pissed that I signed myself out of ER and next day went to my PCP who sent me to a cardiologist and within a week I had heart surgery...
I held no grudges but I have never forgotten the incident either..
Is everyone assumed faking until PROVEN otherwise?
And here is Azygos' reply:
John,
How awful for you to have had to experience such treatment. As a person who has worked ER as a Nurse and as a Nurse Practitioner for 14 years I can tell you that had it been my ER, you would not have been treated as such. I have cared for patients as young as eight who were first diagnosed with a heart problem by me in the ER. Chest pain should always be thought of as real until proven otherwise.
Sometimes nurses get crass and rude the longer they work in the ER. It's fine to go into the closet and point at your head and twirl your finger thinking a patient is faking it or crazy. It's just plain wrong to do it where the patient can see you.
In the ER we get an overabundance of patients saying they are having chest pain. Each should be evaluated on an individual basis and a root cause looked for. Often patients of all ages present with stress induced or anxiety induced chest pain. You can still be crazy and have pain. The art is in delineating between anxiety induced pain and actual physically damaging pain (heart attack). We have extremely sensitive tests now which can tell if heart muscle is being damaged, but we don't have tests other than cardiac cath to tell if a heart is about to be damaged. We have to fall back to our judgment for such things. Twelve lead EKGs, while helpful, are only a snapshot in time and are only good for that moment. One cardiologist I trained with put it this way, it's a ten dollar test and gives you ten dollars worth of information.
Chest pain is radically different from seizures. People rarely die from seizures, but often die from chest pain. Evaluating a seizure to determine if it being faked or not is an art all to itself. I had a 400 plus pound patient faking being unconscious. She was mad at her husband and wanted to make him feel sorry for her after they had just had an argument. I can't tell you exactly how I knew she was faking it but I knew she was. I asked her several times to slide over to the ER bed. Frustrated I finally said, You're too fat for us to lift, you're going to have to move over by yourself. Hearing this she sat bolt upright and started yelling at me. I calmly replied, now that we have established you are awake will you please move to the ER bed.
It's being able to take in the patient as a whole when one is trying to discern if a seizure is fake or not. Did the person urinate or have a bowel movement? People who are faking it usually don't want to pee or poop on themselves to fake a medical condition. Is the person speaking and looking around and following the conversation while having the seizure? Are the person's eyes tracking the sounds of the emergency personnel? Does the patient's Spo2 (Oxygen) drop while having the seizure? Does it look like a seizure? I had one teenage boy try to punch me in the mouth while claiming to be having a seizure (it did not work out well for him).
So in answer to your question- NO, we don't assume someone is faking it when dealing with seizures, but we do take other conditions more seriously as the outcome from a misdiagnosed seizure is almost never fatal, but a missed heart attack certainly could be.
(Hi, it's me again): I would also like to add that you were very lucky... Leaving the ER wasn't the best move on your part, as you were leaving the very place that could have saved your life had you experienced complications. I realize that it can be very disheartening and hurtful to have seen the nurse do this, but it's one nurse. They can't have all been like that. I hope so, anyway. Oh, and I think I know of a couple of people that would disagree about the EKG only being a 10 dollar test...
| Progress Notes (7) |
Progress Notes
In the office you can bill medicare 13 dollars for an EKG. The same EKG in the hospital can be billed at 180 dollars.
added by Azygos on September 9, 2004 6:59 PM
Thank you for responding to my comment with such meaningful information. BTW, I have bicuspid aortic valve. Didn't yet know that when I was visiting that ER 25 years ago but within a week I found it out. Just goes to show that all chest pains should be taken seriously (regardless of age and physical condition)as I'm sure most are now as compared to 25 years ago.
Understanding that there are people who fake things, for God only knows why, does help to see why some proferssionals are on the look out for it.
Your right about going into the supply closet and making gestures about patients. I do similar things myself at my place of employment, but I never dreamed of doing in front of a customer.
Again, Thank you and I'm glad to know that at your Hospital this would not happen.
John
added by John on September 10, 2004 8:27 AM
I found your site through a docblog, and want to say hello. I work in a FQCHC and deliver babies in a community hospital. I am still angry at the 'triage nurse' who ignored my 41 y/o sister in law' "worst headache she had ever had in her life" (and with a hx of a VP shunt placed 10 years earlier) until she collapsed and started seizing from her ruptured aneurysm. Nurse at the urgent care said "We don't have a doc available to see you for your migraine, you will have to come back in an hour" when she should have called the ambulance or at least directed her to the ED. She died after a month in a coma. I know that wouldn't happen in my clinic or in your ED!
What I find frustrating is that we have sent patients to the ED post-ictal from what as far as we could tell in the office was a real seazure, only to be told it was a pseudo seizure. They weren't there watching it happen, seeing the O2 sat drop etc.
added by alicia the midwife on September 18, 2004 7:14 AM
It just amazes me how nurses can be so stupid. Just hearing that a patient has a VP shunt should have triggered all the bells and whistles in the place. Those things do plug up and get infected causing serious illness.
Just to clarify to non-medical people: When you have the worst headache of your life then it’s time to head for the nearest ER or call 911 if you can’t drive. Expect that the doc is going to get a CT scan of the head. If that is negative the doc will probably want to do a lumbar puncture. Both very reasonable and expected procedures. And make sure to take someone with you who will advocate for you with the staff and doc’s. That person is supposed to be the Nurse but, as we see from the above comment it doesn’t always work the way its supposed to.
added by Azygos on September 18, 2004 3:26 PM
Granted it was an urgent care setting and not an ED, but in our ED the simple comment of Alicia's sister-in-law about the worst headache of her life would have had her brought straight back from triage, shunt or not. BUT that is a real ED, with real ED techs, real ED nurses, and real ED docs -- not a freestanding clinic staffed by a GP (or GNP/PA), RNs or LPNs with a variety of experiences, and CNA/M.A.'s.
I say "granted it was an urgent care setting" in mild (very mild) defense of the original nurse. I think it's a bit unfair to label him/her "stupid" based on so little information. While a critical nurse may -- should, even -- recognize such an emergent situation, that's simply not the case with nurses in general. Perhaps that urgent care nurse's background was in school nursing, occupational medicine, sports medicine, dermatology, or any nursing area that doesn't often see cases like this. Remember that nurses with critical care skills and training are very likely working in critical care, not urgent care clinics. Even (I assume) the nurses you work with, Alicia: I'd bet there are plenty of L&D, mother/baby, and NICU nurses who wouldn't recognize your sister-in-law's situation.
Switching to my cynical defensive invite-everyone-to-rip-me-a-new-one ER tech hat: with a shunt and the worst headache of her life, why did this woman go to an urgent care clinic an not to an ED or call 911 herself?
Mike
added by Mike Morgan on September 19, 2004 7:39 PM
What is it with aneurysms that more and more people seem to have them? Maybe it is just the people I know but aneurysms has effected 3 people in my life in the last 3 years. My good friend who was 45 years old came home from work one day last year having the worst headache of her life. She told her husband she was going to lay down for awhile and then get up so they could take their 4 children out for dinner. She never got back up, she experienced a ruptered aneurysm.
4 months ago I a co-worker that had complained of headaches for months. She saw various Drs. who kept prescribing medications for pain. I'm saddened to say that rumor had it that she was probably just addicted to pain pills and using the migraines as a way to obtain them. She finally saw a neuro doc who ordered tests and found she had 2 aneurysms. She had surgery at CCF and is doing well now.
The third was a male friend of my husbands who went to work one day complaining of a horrible headache. His boss tried to send him home but he refused. He passed out at work, was taken to ER. He was transported to CCF where he underwent surgery. However, he went into a coma and died within weeks.
These were all middle aged folks who until this happened appeared healthy in every way possible..Very scary!
added by Cathy on September 20, 2004 6:11 AM
I had an incident with a pregnancy that led to 3 ER visits. I had begun bleeding in the last part of my first trimester. I go to the er, they send me home, stay of fyour feet. The problem got worse, back I went. Send me home, stay off your feet. To this point I hadn't seen an ob doc (at the er, but had one for normal visits). In fact the second visit the doc from OB REFUSED to see me. Begininng on oct. 30, this started until my final vist to the hospital on dec 4. I actually am allowed to go upstairs to the OB dept. I am by now having labor pains and along with a worsened already mentioned problem. 3 hours i wait, i do see a doc (mine during each of these visist was "unavailible") he tells me "you would get not better treatment here than you would at home." So he sends me home, without doing any real tests, well they did 9 drugs test, but that was the extent of my labs. I had the baby at my house in my bathroom less than 10 hours later. He lived.. for an hour and a half. Then due to only being barely 6months along his little lungs gave out. 1st responders tried all they could, but weren't equpied to handle a neo-natal emergency.
added by Dream Mistress on September 30, 2004 7:20 AM
So, what brought you to the hospital today?