Written by: Aaron Wibberley, MD (PGY-2) Edited by: Kaitlin Ray, MD (PGY-4) Expert commentary by: Chris Lipp, MD
Expert Commentary
Malingering is a patient behaviour with a profound hazard: the misdiagnosis of a “deceptive” patient who in reality has a serious medical illness. Chief complaints associated with malingering may coincide with a vast differential of possibilities: neck pain, symptoms after head trauma, and abdominal pain. Just like musculoskeletal back pain is a diagnosis of exclusion for a patient presenting with acute discomfort, malingering can be considered when a patient has been thoroughly assessed based on their history and physical examination (with appropriate diagnostic testing). Tools exist to help psychiatrists, neurologists and occupational physicians in diagnosing malingering, but these are largely out of the skill set of most emergency physicians. To determine if malingering should be suspected there are several questions to consider: are there any rewards the patient may be seeking after? What incentive may the patient have to seek after hospitalization, time off work, or addictive medication prescriptions? In most cases a team-based approach involving interdisciplinary professionals and sufficient collateral information are required to (1) make the diagnosis of malingering substantiated and (2) free from the excessive medicolegal risks of misdiagnosis. Emergency department clinicians must vigilantly consider malingering, factitious disorders, and other psychiatric illness as diagnoses of exclusion.
Chris Lipp, MD
Attending Physician
Calgary Emergency Medicine
Author at CanadiEM
Co-Founder of CRACKCast
How To Cite This Post
[Peer-Reviewed, Web Publication] Wibberley, A. Ray, K. (2020, Feb 24). Malingering in the ED. [NUEM Blog. Expert Commentary by Lipp, C]. Retrieved from http://www.nuemblog.com/blog/malingering
