Munchausen by proxy; How could it be missed?

[Nucleus Accumbens]

Mommy Dead and Dearest (2017) - The murder of Deedee Blanchard by her daughter Gypsy Rose is explored, as well as the circumstances leading up to the event. • r/Documentaries

Friend sent me this really interesting story of a woman who was convinced for several years that she had leukemia and could NOT walk by her own mother!!! Long story short, she finds out that she was lied to in her twenties and conspires to, and follows through with the murder of her mother.

So, as a clinician, how do you not perform a full CNS work-up and realize that she has preserved deep-tendon reflexes (even if she had a conversion disorder, you can't hide reflexes)? From there you could start digging and hopefully uncover the bells and whistles distracting them from the real disorder of Munchausen by proxy. It seems to me like a massive oversight took place here that resulted in a woman losing her life in the literal sense and a girl losing her life to prison and likely decades of therapy.


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[Strider_91]

This is an important lesson that shows as a physician you must always take the time to gather actual records and tests from other physicians that have treated the patient. You cannot always take the patients word about what they have been diagnosed with. Get the records and tests no matter how terrible the insititution they are coming from is about getting them.

 

[sonofva]

This is an important lesson that shows as a physician you must always take the time to gather actual records and tests from other physicians that have treated the patient. You cannot always take the patients word about what they have been diagnosed with. Get the records and tests no matter how terrible the insititution they are coming from is about getting them.

I feel like most of the time you can never take the patient's word. When it comes to their care most people are either unintentionally giving you misinformation with no malicious inten or outright lying to you. Most people cant remember the name of like 2 pills that they have taken every day for years. How can you expect them to relay the results of a complex medical test?

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[Nucleus Accumbens]

This is an important lesson that shows as a physician you must always take the time to gather actual records and tests from other physicians that have treated the patient. You cannot always take the patients word about what they have been diagnosed with. Get the records and tests no matter how terrible the insititution they are coming from is about getting them.

I agree. What is extremely distressing about the management of this patients care was the willful ignorance towards EBM. Duchenne's needs confirmatory muscle biopsy with genetic testing. Not to mention for monitoring serum CK for progression. They just assumed she couldn't walk bc the mother said so, but why the hell didn't the doctor ask the patient?! Very troubling story.


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[jm192]

IMHO I'd check the hubris and recognize this as a cautionary tale, rather than an opportunity to gloat over/chastise the many different doctors involved in the situation.

This.

We all make mistakes, and it's much easier to see where someone else screwed up than to recognize our own. While it's sad this went unrecognized, it's important for physicians to stick together rather than belittling mistakes.

 

[MediCane2006]

As I recall there was at least one doctor who was suspicious and wanted confirmatory testing, but the mother was a doctor-shopper that changed physicians frequently.

 

[Nucleus Accumbens]

IMHO I'd check the hubris and recognize this as a cautionary tale, rather than an opportunity to gloat over/chastise the many different doctors involved in the situation.

Fair enough. I can't say I would've done anything particularly different. But hindsight is 20/20 for these docs I'm sure. I agree on this being something we should learn from I'm sure. It just seems so crazy how no one bothered to confirm a disease like DMD!


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[Nucleus Accumbens]

As I recall there was at least one doctor who was suspicious and wanted confirmatory testing, but the mother was a doctor-shopper that changed physicians frequently.

Ya that was kind of annoying since he stated that he suspected it but didn't feel like it was his place to go further with the matter due to the families social support base. There's your first systematic issue.


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[NickNaylor]

Thanks for mentioning this - gunna watch it tonight. The first ~20 minutes are absolutely fascinating - and horrifying.

 

[sliceofbread136]

I dunno some people seem mildly hyper reflexive at baseline and reflexes are somewhat subjective to begin with. I could see it being missed.

 

[Nucleus Accumbens]

This.

We all make mistakes, and it's much easier to see where someone else screwed up than to recognize our own. While it's sad this went unrecognized, it's important for physicians to stick together rather than belittling mistakes.

One thing to belittle, which I don't think I was doing. Who will hold you accountable if not for other physicians? If it was an honest mistake then let's whip out the fishbone diagram and figure out where you or your team screwed up.


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[Foot Fetish]

Mommy Dead and Dearest (2017) - The murder of Deedee Blanchard by her daughter Gypsy Rose is explored, as well as the circumstances leading up to the event. • r/Documentaries

Friend sent me this really interesting story of a woman who was convinced for several years that she had leukemia and could NOT walk by her own mother!!! Long story short, she finds out that she was lied to in her twenties and conspires to, and follows through with the murder of her mother.

So, as a clinician, how do you not perform a full CNS work-up and realize that she has preserved deep-tendon reflexes (even if she had a conversion disorder, you can't hide reflexes)? From there you could start digging and hopefully uncover the bells and whistles distracting them from the real disorder of Munchausen by proxy. It seems to me like a massive oversight took place here that resulted in a woman losing her life in the literal sense and a girl losing her life to prison and likely decades of therapy.


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How could those medical peons be so foolish as to not see this rather elementary case of MBP, am I right? @SouthernSurgeon

Lmao

 

[jm192]

One thing to belittle, which I don't think I was doing. Who will hold you accountable if not for other physicians? If it was an honest mistake then let's whip out the fishbone diagram and figure out where you or your team screwed up.


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"How do you not...?"

1. What's your level of training? I'm guessing medical student.

2. Your tone isn't an attempt to "hold accountable" It's an attempt to make yourself sound enlightened whereas those involved were not.

Before it's all said and done, a large chunk of us will be in a court room with some jerk off attorney asking whether or not we knew Heparin could cause a bleed. It would make sense to say "What would you do to avoid missing such a thing."

But when you word it such as "How do you not..." you do come across as if you have some sort of credibility in regards to the issue, and you do not.

We're not talking about a situation where a patient had a fever and a white count and no one bothered looking for infection. You're talking about a very complex problem.

And your tone makes you sound like a royal douche, and I look forward to never working with you.

 

[Psai]

Man I've been trying to avoid posting here but the medical student attitude here is too ridiculous to ignore. Have you ever called medical records 10 times and faxed a consent multiple times just to get a single document? A lot of times, patients don't even know the names of their doctors or the location of the hospital they were seen at. We are incredibly busy with many patients coming in and out. We barely have time to do our own work, never mind replicating everything other doctors have done already. A lot of what we do is based on trust. Don't have time to order a1cs on every person who says they have diabetes. Can't go around confirming every single diagnosis a patient has.

"massive oversight"

"willful ignorance towards EBM"

"do a fishbone diagram to see where the team screwed up"

Get over yourself. You're not as clever and special as you think you are.

 

[throwaway-peds2017]

Mommy Dead and Dearest (2017) - The murder of Deedee Blanchard by her daughter Gypsy Rose is explored, as well as the circumstances leading up to the event. • r/Documentaries

Friend sent me this really interesting story of a woman who was convinced for several years that she had leukemia and could NOT walk by her own mother!!! Long story short, she finds out that she was lied to in her twenties and conspires to, and follows through with the murder of her mother.

So, as a clinician, how do you not perform a full CNS work-up and realize that she has preserved deep-tendon reflexes (even if she had a conversion disorder, you can't hide reflexes)? From there you could start digging and hopefully uncover the bells and whistles distracting them from the real disorder of Munchausen by proxy. It seems to me like a massive oversight took place here that resulted in a woman losing her life in the literal sense and a girl losing her life to prison and likely decades of therapy.


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Did you watch the documentary? One of the neurologists did exactly this and wrote "Munchausens by proxy" in his note. The lawyer goes over it with the child's father (living in another state) and stepmother...
The mother was always getting copies of medical records and when she saw it she switched hospitals

 

[popopopop]

Youtube vid down from link, but there's another one uploaded.

 

[jm192]

Man I've been trying to avoid posting here but the medical student attitude here is too ridiculous to ignore. Have you ever called medical records 10 times and faxed a consent multiple times just to get a single document? A lot of times, patients don't even know the names of their doctors or the location of the hospital they were seen at. We are incredibly busy with many patients coming in and out. We barely have time to do our own work, never mind replicating everything other doctors have done already. A lot of what we do is based on trust. Don't have time to order a1cs on every person who says they have diabetes. Can't go around confirming every single diagnosis a patient has.

"massive oversight"

"willful ignorance towards EBM"

"do a fishbone diagram to see where the team screwed up"

Get over yourself. You're not as clever and special as you think you are.

100x this.

 

[Zebra Hunter]

One of my favorite things to do is call out drug seekers that lie about having sickle cell disease. At least do your frickin research before trying to trick a doctor into giving you dilaudid.

Me- "Do have HgbSS, SC, sickle beta thalassemia, sickle cell trait?"

Pt- "I don't remember"

Me- "Who diagnosed you then?"

Pt- "My doctor"

Me- "What kind of doctor was he?"

Pt- "I don't know"

Me- "You look pretty good for a 40 year old sickle cell patient. Do you have any hip replacements, hx of splenectomy, etc? Are you on hydroxyurea?"

Pt- "What's that?"

Me- "Well just to let you know, your hemoglobin count is 14, you have no evidence of sickling on your peripheral smear, we are running a hemoglobin electrophoresis on your blood to confirm you don't have sickle cell disease, I have run your name through our states controlled substance monitoring database and found that you have been to 3 other ERs this week and were prescribed opiate pain medication, and if you ever try to pull this stunt again, I will call the police on you."

 

[mvenus929]

Even within the same hospital system, sometimes medical child abuse can be difficult to catch. We had a patient with some genetic mutation of uncertain significance--I think he was mildly dysmorphic, which prompted the testing, and something that wasn't fully understood came up. Every thing that happened afterwards was due to this genetic problem. He had failure to thrive, and GI had the hardest time trying to get him to gain weight.

After multiple hospitalizations, there was concern raised that the parent might be doing something to prevent him from gaining weight. After investigation, he was eventually put in medical foster care, and hasn't been back in the hospital in the past several months.