Most self reported information is either supported, or not supported by objective signs. What we get to do is to combine the subjective statements with the objective observations to make a complete picture.
For example: A patient complaining of SOB, may exhibit adventitious breath sounds, a low SpO2 reading, tachypnea, diaphoresis.
Or they may complain of SOB, and exhibit, hand tingling, clear Breath sounds, normal SpO2 reading, tachypnea....
Both patients are having a respiratory difficulty: One is acutely SOB for some reason (Asthma, Emphysema, CHF overload etc). The other is probably hyperventilating. Requires different treatment, even though both patients may present saying, "I can't breathe" Both require treatment.
Hyperventilation may not rank high on your idea of a medical problem, but for the patient it is. We get into trouble when we judge people for their complaints. But we do have to be able to match the subjective with the objective....
It is difficult to assess someone elses pain, and decide if they warrent pain medication or not, so I always go wiht the patients assessment of pain. This can be pretty hard to swallow when a patient states 10/10 pain and is merrily talking on a cell phone, clicking away at the TV... But better to err on the side of giving relief, than withholding because you made a decision to withhold based on your personal criteria for "What people in pain look like"...
Patients (who incidently are also health care providers), often manipulate the system for things like work excuses, pain medications, familial attention, disability benefits. It is important in these situations to stay neutral. If you suspect a patient is having a problem with addiction to prescription drugs, this may need to be assessed, but it is difficult to get this done- as drug seeking patients visit many different Emergency dept and are quite cunning in knowing how to obtain meds and create symptoms. It's also important to realize that the drug seeking is not personal- these patients have a problem and need assistance- like most patients, unfortunately their problem is that they are hooked on Rx meds. Most Nurses get into problems when they start to take the drug seeking behavior (which is often trying to patience) personally. The patient would have presented no matter who was working. (I try to tell myself ALL patients are seeking drugs, just some of them want antibiotics, antihypertensives, antiemetics...) Some things can be done via process to discourage this: for example, many hospitals have stopped using Demerol as it is not a great drug and gives drug abusers quite a high. We have stopped using Promethazine for many patients due to the side effects, preferring Ondansterone- which has less of the desired side effects that drug seekers desire, and very good anti-emetic effects. Someone initially prescribed these people these drugs, so many physicians are also under fire for unusual prescribing habits. Some of my worst drug seeking patients are "retired" nurses.
I stay neutral in family arguements, when someone in the hospital is playing martyr, and trying to manipulate other family members. This means, I make no statements about family members (unless it is an abusive situation), nor do I endorse any sort of comments such as "If you had agreed to bring Jimmy sooner, he wouldn't have gotten sick" This statement may be true, but, I try to say, "well, Jimmy is here now, so we will do what we can..." It is up to the family, not me, to sort out their issues.
I do the same for work notes. If a physician gives a work note, I give it, if not, I explain that I can not. Unless it is an obvious oversight by the physician I don't get involved. SOmetimes it is obvious that the person could go back to work, but I do not want to get into a mental pissing match over someone elses 1 day off work.
If a patient is on disability- and should not be, I suppose that should be reported to the appropriate people, but seems many times our documentation is what supports the disability, and some agencies encourage a certain type of documentation that allows their patients to stay on the accounts.
As far as lying about symptoms for attention. Well, most of us don't have enough time to be giving extra attention, but it is pretty easy to verify using clinical studies their complaint. If they continue to be attention seeking in dramatic ways (c/o can't move my arm, walk, etc) they usually end up getting a psych consult- which embarasses them and either sorts out an underlying problem (had a woman who used to consistently intoxicate herself with water...psych consult revealed all sorts of stuff, but she had been hospitalized over 20 times before this was suggested!) or the patient stops the behavior.
All that said, it is important to trust the patient. Some patients do not have a lot of experience with pain, and so a stubbed toe is agonizing...most really just want to get better, unless they give me some sort of overt signal I err on the side of trusting.
Oh my, well, I've written a book. Hope this helps.