This is by far one of the worst/most difficult aspects of our profession to me. If there's anything that grinds my gears, it's being manipulated by secondary gainers. Even worse still when they're enabled by family members at bedside.
Lol, I had the mother of a pseudopseudoseizure patient (what I call the malingerers that are doing it for secondary gain rather than it being a stress reaction) who came in for the 4th time in a week for her “episodes”. I had already seen them earlier in the week and told the mother that her daughter was having pseudoseizures which of course the mother was furious about the diagnosis stating “the ‘epilepsy’ blogs told me you would say that“. She had traveled an hour to our hospital because all the hospitals around them reportedly refused to see the patient anymore. So the second time I saw them for the same “seizures” that I was able to stop by completely ignoring her and calmly talking with the mother while the mother is panicking while the patient flailed on the bed in a terrible impression of seizure. The patient clearly annoyed that I am giving her no attention, stops seizing, and in an attempt to feign a post ictal phase sits up immediately after the “seizures” stopped and says “Dr. Zebra Hunter, who is that next to you?” Speaking of her mother.
To which I reply “So you can remember my name but can’t remember your mother?”
“That’s my mother? I don’t recognize her.”
To which her mother responds “How can that be pseudoseizures doctor? She can’t even recognize me.”
I then give her a long spiel about how stress reactions can manifest differently, and trying to put in the kindest way possible that her daughter is not experiencing organic seizures. Also discuss how I would strongly encourage she see a psychiatrist which of course gets the mother even more mad.
Then she starts doing this cyclical line of questioning that all psych patients do when you explain to them that their symptoms are likely a somatization. “But how can you explain her not recognizing me?”
“Ma’am like mentioned before, stress reactions can manifest in many different ways...”
“Yeah, you’ve already said that, but there is no way that pseudoseizures can cause her to forget me, how can you explain that?”
“Ma’am, I think you are misunderstanding what I am saying, pseudoseizures are also a physical manifestation of stress reactions.”
“But look at her, she’s not even stressed. How can you explain her not knowing me?”
At this point I’m just fed up with the stupidity of the patient and mother and the ridiculous patient satisfaction facade I had put up that clearly is going nowhere with them and I finally said , “Ma’am it is because your daughter is faking this. All of it. I don’t have a definitive reason why, but I can tell by your reaction here that it is likely because you give her so much attention every time she has an episode.”
At this point the room blows up, the patient is yelling that she is going to ****ing kill me, the mother yelling at me for being a terrible doctor, and I turn around to cover my smile while I grab the charge to call security to escort the patient and mother out for threatening me.
pubmed.ncbi.nlm.nih.gov
