Thank you all for your contributions and discussion. I've been really impressed by the level of knowledge and discussion. DocVikingo's description is both accurate and elegant. To what he(?) said, I would only add that the incidence of factitious disorder is generally estimated in the medical literature to be 0.6 to 1.3% of general hospital admissions. Like all deceptions, many cases are never discovered. One of the best studies ever done was by Anthony Fauci (now director of the NIH institute for allergies and infectious diseases) when he was a fellow (trainee) in 1979. In the era before ethics and consent, his team was investigating the cause of patients who had fevers of unknown origin. This was an "elite" population of patients who had been evaluated by local doctors, local hospitals and academic centers with no cause found. By spying on them (without their knowledge) and keeping track of mercury thermometers (each had a serial number) they were able to demonstrate more than 9% of the patients exhibited factitious behavior such as shaking down the thermometer, putting it in coffee, switching a raised thermometer while a nurse was not looking. One patient was noted to have used an unusual form of friction to raise the thermometer's temperature....
So it happens more than we think. A large prospective hospital population study in a highly regulated hospital system in the Netherlands found that 3% of patients admitted for inpatient care had no organic cause (although presumably not all were factitious).
The costs are enormous in terms of wasted laboratory tests, imaging and resources. It also puts the patients at risk as many procedures have small but real risks and some patients engage in behavior which leads to unnecessary surgery or exposure to anesthetic. There is also a cost others as it potentially delays the use of MRI, operating rooms and yes, hyperbaric oxygen chambers from other patients. But fundamentally these people carry an enormous amount of distress and internal pain with them as evidenced by the lengths they go to in order to be cared for.
As DocVikingo and the Duke Dive representative state, many factitious patients are very sophisticated; studies suggest that 1/4-1/2 have some degree of formal medical training as medical students, nurses, laboratory techs, medical clerks or so on. Many others have had medicalized lives with long histories of prolonged ("real") childhood disease or family members with prolonged medical illnesses. The simpler patients are weeded out. I'm sure we don't detect the most sophisticated and successful - partly because the general assumption of clinicians is that they are working hard to understand and hopefully help what is wrong with people, while most clinicians accept that patients may provide misinformation, few start with the assumption that the underlying presumption of illness is false.
The other issue is that factitious disorder is a psychiatric disease but the vast majority of the patients are seen by non-psychiatrists (emergency docs, internists, surgeons). The psychiatry service is only called when it becomes "obvious" that something doesn't make sense or laboratory values become inconsistent.
And Knotical, the idea that divers are a "special" population probably doesn't hold water (sorry). Highly trained and "fit" groups such as the military, pilots and teachers and others have had factitious behavior reported. Even lawyers.
Thank you again for the discussion; if any of the dive docs have had a case, I'd appreciate a private message.
So it happens more than we think. A large prospective hospital population study in a highly regulated hospital system in the Netherlands found that 3% of patients admitted for inpatient care had no organic cause (although presumably not all were factitious).
The costs are enormous in terms of wasted laboratory tests, imaging and resources. It also puts the patients at risk as many procedures have small but real risks and some patients engage in behavior which leads to unnecessary surgery or exposure to anesthetic. There is also a cost others as it potentially delays the use of MRI, operating rooms and yes, hyperbaric oxygen chambers from other patients. But fundamentally these people carry an enormous amount of distress and internal pain with them as evidenced by the lengths they go to in order to be cared for.
As DocVikingo and the Duke Dive representative state, many factitious patients are very sophisticated; studies suggest that 1/4-1/2 have some degree of formal medical training as medical students, nurses, laboratory techs, medical clerks or so on. Many others have had medicalized lives with long histories of prolonged ("real") childhood disease or family members with prolonged medical illnesses. The simpler patients are weeded out. I'm sure we don't detect the most sophisticated and successful - partly because the general assumption of clinicians is that they are working hard to understand and hopefully help what is wrong with people, while most clinicians accept that patients may provide misinformation, few start with the assumption that the underlying presumption of illness is false.
The other issue is that factitious disorder is a psychiatric disease but the vast majority of the patients are seen by non-psychiatrists (emergency docs, internists, surgeons). The psychiatry service is only called when it becomes "obvious" that something doesn't make sense or laboratory values become inconsistent.
And Knotical, the idea that divers are a "special" population probably doesn't hold water (sorry). Highly trained and "fit" groups such as the military, pilots and teachers and others have had factitious behavior reported. Even lawyers.
Thank you again for the discussion; if any of the dive docs have had a case, I'd appreciate a private message.
