How do you deal with Munchhausen-type pts?

CBlover, BSN, RN · Aug 10, 2015

I can COMPLETELY relate. I've had one for sure that I know of. This pt's PCP finally said "ENOUGH" and would no longer remain her PCP. This pt has their family completely fooled. I've had another who like you said, either really fooled her family well or was really sick. It is sooo hard to tell on some. After several admissions I've really wanted to say something to the pt, but I know I can't. It's one of the saddest things isn't it?

Jensmom7, BSN, RN · Aug 10, 2015

Can't say I've ever had a Munchausen's patient, but back in the early 80s several of my co-workers and I were convinced we had a parent with Munchausen's by Proxy.

She got away with it for a few years, and then one time misjudged how long she could withhold her kid's seizure meds before rushing him to the ER to be "saved". (Her story was that he would periodically vomit them up. Never once did it while he was in hospital, however). He came in DOA.

Sad thing was, we had brought up the possibility of Munchausen's by Proxy several months earlier with his Pediatrician. He reamed us royally and pretty much told us to stop practicing Medicine without a license. Granted, the child really did have multiple illnesses and his symptoms were caused by mom deliberately withholding meds, but she fit the rest of the profile to a "T".

Thirty years later and I still think of that little boy. Both Munchausen's and Munchausen's by Proxy are difficult to deal with, and I'm not even really sure that intensive Psych intervention helps. From what I remember, there's a personality disorder component involved. And you can't cure a personality disorder.

jadelpn, LPN, EMT-B · Aug 10, 2015

Not your job to figure out what is real and what isn't. You can only take information as presented to you, do your assessment, and plan care accordingly.

Regardless of how you feel, this is real to a patient.

If there's no end in sight to multiple complaints and issues, time to advocate for a care conference will all disciplines to best serve the needs of the patient.

If the patient can not function, perhaps they need a long term care solution. That is something you can discuss at the care conference.

Here's a little story from my experience. Patient who was admitted constantly, continued to--what we all thought--up the ante. New stuff constant. Long story short, they had a brain tumor and were dead 2 weeks later. Is this the norm? Not always. But never suspect that it is a pysch/all in one's head issue--it could be something else entirely.

So, remember, real to them is real to them. You can only advocate.

iluvivt, BSN, RN · Aug 10, 2015

Yes! We have several now and eventually their antics are revealed.We have one diabetic that enjoys being ill for the attention and narcotics. They determined that this person takes a large dose of steroids to elevate her blood sugar as well as manipulating their medication so it rises. We still have to treat in this case and they are getting this person some psychological help. I agree its frustrating when someone intentionally makes themselves ill or someone else and they seem to thrive on the attention. These are very troubled people indeed.

Karou · Aug 10, 2015

I have had many patients I suspect have faked and or forced illness.

Apparently it's extremely difficult to get a solid diagnosis. We had one patient with multiple admissions and actual proof of tampering on her part (video proof as well as objective charting over a span of several years). Psych on board. Still were hesitant to diagnose her. Eventually they started admitting her with it as a "possible" diagnosis. Her doctors began to refuse her after they realized how futile it was. She refused to follow up with psych. Haven't seen her in a while...

She was a sad, sad person and I felt extremely sorry for her. A few of her doctors expressed true sadness when they gave up her case, but she wouldn't follow their treatment plans and intentionally sabotaged herself.

NurseGirl525, ASN, RN · Aug 10, 2015

I agree that it's not your job to decide that. There are many conditions that don't show up on a test, but the person really does have something going on. Imagine how frustrating it must be for a patient who feels terribly ill, but all the tests in the world come back normal. It is frustrating. You know something is wrong with your body yet nobody can tell you what that is. You will honestly sit there and wish for something, anything to come back abnormal so they can put a name to your condition and finally treat it. Munchausen's is not normal. It is not normal for someone to purposely make themselves sick for attention. More likely, they just can't put a name to what is going on with this person yet.

I used to watch Mystery Diagnosis on tv and the one common phrase I would hear from each of those people was, they just wanted a diagnosis. I have seen what I think would be relatively easy things to diagnose take people over 5 years to get an answer on. One woman they showed, the minute I saw her on the screen I said she has Cushings. She did. It boggled my mind that I could clearly see what took her over 3 years to get a diagnosis on. For most of these people, it takes getting into the right doctor, who is going to take the time to really listen to what their patient is saying and not the standard 5-10 minute visit, throwing every med in the world at it and hoping something sticks. Unfortunately that is what happens a lot of the time anymore with lower reimbursements and more patients coming in. I know sometimes with me over the years, I have had to search out the right doctor who was going to work with me to get me where I needed to be. Nobody wants to feel ill, nobody wants to be in constant pain. That's why I say Munchausen's is not common. Most people want relief.

xoemmylouox, ASN, RN · Aug 10, 2015

I work with someone that many of us believe fit this dx. She had also used her daughter as a proxy. I'm not sure how the daughter is doing since the parent changed PCPs out of our affliated office. Mom was sick of the MD never addressing the non-existant problems of her daughter. For the longest time she kept demanding a T&A, but none of the ENTs would do it because it simply was not needed. The tonsils were not swollen and pt was not sick often. She had no sleep apnea or mouth breathing problems. It is sad because the attention seeking becomes so obsessive and dangerous. My coworker nearly killed herself by exposing herself to a known allergy and going into anaphylaxis. Luckily since that incident her behavior has tamed some. I believe that scared her a bit. That was about a month ago. We shall see how long this lasts.

Anna Flaxis, BSN, RN · Aug 10, 2015

I've had many patients over the years with various attention seeking behaviors. I treat them the same as any patient- address their symptoms, explain the rationales for each diagnostic and treatment, set reasonable boundaries, explain what they can expect and what the limitations of our interventions are, etc. Calling them out or confronting them on their behavior is not therapeutic, and as tempting as it is to do that, it would only be self serving and not helpful to the patient.

mmc51264, BSN, MSN, RN · Aug 11, 2015

I'm not trying to dx thispt, I was just curious if others had these types of pts. I am a fierce advocate for my pts and it was after a couple of days I figured somethings were not adding up. I treated this person like I do all the others. I just was sharing a different experience. NOt going to give any kind of details, but there was some weird stuff.

CBlover, BSN, RN · Aug 11, 2015

I agree that it's not your job to decide that.

I don't think any of us are diagnosing these pt's with such a disorder, but I'm sorry there are one or two that you just can't help but think they may have Munchausen's. If you had seen one pt of mine you would've have thought the same thing. Even the MD agreed and mentioned it in her H&P.

AnnieOaklyRN, BSN, RN, EMT-P · Aug 11, 2015

It can be very frustrating when you feel someone is just looking for attention from healthcare providers and they are not really sick.

My mother, I believe, has this disorder, although I have no proof since she will not seek therapy as many doctors have told her too. She is at different Drs offices 2-3 times a week and literally has surgery every six months, the last surgery was sinus surgery and the doctor came right out and said "I told you I don't think you really need this surgery, but I am doing it because you insisted on it". She always has "side pain" which we will seek out surgeons until she can convince one that she has adhesions and needs surgery. She literally has no more parts left to remove. She convinced a surgeon that she needed her gallbladder out, not a single stone in it and normal function when they did some tests down in radiology! I don't understand why these physicians still take her to surgery. She has a TWO and a half page TYPED list of all the surgeries she has had (she is 63). I can tell she enjoys the attention! She had rotator cuff surgery a few months ago and convinced them that she needed a night in the hospital because NO ONE would care for her at home, which was a total lie, again she wants the extra attention. She tried to convince them to put her in a rehab for that!!!!!! I couldn't believe it, I told her all about the MRSA, CDIFF, and all the other infections she would catch.

I am to the point where I am frustrated because I feel like she does this for attention and I don't understand, I am a normal person that would NEVER want surgery that is not needed and she WANTS all the surgery she can get. I am at my wits end and will be telling her the next time she 'needs" surgery I will not drive her unless I speak to the doctor myself and find out how necessary it is.

I try not to judge patients based on my experience with my mom, but I cannot help it, I can easily read when someone is playing the drama card for attention!

Annie