Difficult Patients: Malingerers, Feigners, Chronic Complainers, and Real Imposters

Area of Science:

• Emergency Medicine
• Medical Ethics
• Psychiatry

Background:

• Malingering involves intentionally faking or exaggerating symptoms for external or internal gain.
• The actual prevalence of malingering in emergency settings is unknown due to diagnostic challenges.
• It is typically a diagnosis of exclusion, requiring careful consideration of differential diagnoses.

Purpose of the Study:

• To provide a framework for emergency physicians to diagnose malingering.
• To analyze case studies of suspected malingering from a medical ethics viewpoint.
• To offer practical strategies for managing patients with suspected malingering.

Main Methods:

• Literature review on malingering diagnosis and management.
• Analysis of anonymized case studies presenting suspected malingering.
• Development of a differential diagnosis framework for emergency physicians.
• Application of the NEAL (neutral, empathetic, and avoid labeling) strategy.

Main Results:

• Malingering presents diagnostic challenges in emergency departments.
• A differential diagnosis framework can aid physicians in identification.
• Case studies highlight ethical considerations in managing suspected malingering.
• The NEAL strategy offers a practical approach for patient interaction.

Conclusions:

• Accurate diagnosis of malingering in emergency departments is complex.
• A structured approach and ethical considerations are crucial.
• The NEAL strategy is recommended for empathetic and effective patient care.
• Further research is needed to understand the true incidence and impact of malingering.