Screening a Suspected Malingerer Using the Symptom Checklist-90-Revised and Visual Analogue Pain Scale Questionnaires

Malingering in healthcare leads to a significant financial burden, so identifying patients who may be more likely to malinger is a critical step in minimizing the ever-growing cost of healthcare in the United States. Malingering is a clinical diagnosis with no well-established diagnostic tests. General guiding principles exist to determine whether or not a patient is malingering, but there is no well-established set of guidelines that can be used in common to identify malingering. Our team cared for a 51-year-old black, female patient who presented to an outpatient clinic due to generalized pain following a motor vehicle accident (MVA). The patient's symptomatology, clinical progression, and imaging results were discordant with one another, which prompted clinical suspicion of malingering. After careful deliberation, the care team suspected that the patient was malingering. Therefore, the clinical management was limited to a conservative pain management regimen and minimal clinical follow-up to avoid unnecessary healthcare expenditures. This article aims to discuss general principles and specific strategies for how a clinician can approach a case of suspected malingering.