Recently saw a 50 something year old gentleman with supposed sickle cell disease who still had both native hips, no heart failure, no strokes, no CKD, or any other medical co-morbidities. I found all of that to be beyond abnormal given the low life expectancy and the typical disease burden of someone living that long with SCD. He is apparently a regular at our hospital presenting to the ER at least 5-6x/month and being admitted 1-2x/month and has been doing this for the last 3 years. He was of course presenting for his typical chest pain and pains everywhere and apparently ran out of his pain meds for the 3rd time in last 2 months. I looked back at all his previous presentations which were likely >100 total, and found that he did not have a single heme/onc consult despite years of presentations and no one even bothered to run a Hgb electrophoresis on the guy. He just got his typical 2-3 rounds of dilaudid and then admitted if still requesting meds. I even looked back at all his previous admissions and found that not a single physician openly questioned his reported medical history. Stranger was the fact that apparently hundreds of doctors were perpetuating this cycle of chronic dilaudid despite the patient consistently having a Hgb between 14-16 which is completely unheard of for SCD. I confronted him about this and he said "Oh, I have Hgb SC" which typically have higher Hgb levels, but should still typically be lower than normal and still frequently carries much of the same disease burden as Hgb SS, although typically less severe.
I ordered basic labs and tacked on a hgb electrophoresis, gave him some toradol, and discharged him after his labs all came back normal for the 100th time, with the electrophoresis still pending. His electrophoresis of course eventually came back demonstrating that he had sickle cell trait which I figured was going to be the case, and had 0% Hgb C. Despite the electrophoresis results and me clearly stating in my note that the patient was unlikely to have sickle cell or Hgb SC, the next two ED docs that saw him admitted him and he continued to get round the clock dilaudid during hospital admission. I think at least 10 other docs have now seen him since the last time I saw him and they continue to treat him for his "sickle cell disease" despite his hgb of 15 and an electrophoresis that clearly demonstrates SC trait on his chart. I just don't understand how a bunch of trained physicians can miss such an obvious case of malingering. I've caught people faking sickle cell disease before, but they usually get caught within the 1st or 2nd time of attempting the ruse, at least where I trained at in residency. The only logical conclusion I can make is that none of these docs have any experience with sickle cell disease given that we are in a low prevalence area, although that really shouldn't be an excuse given how obvious this case is.
I'm pretty sure I have a few others like this, as I enjoy catching high resource utilizers in lies regarding their medical history; however, this case is fresh on my mind. Anyone have similar experiences?
