Munchausen's??

My first thought is- can you smell vomit out of the barf bucket? Even if she washed it there should be an odor.

If you promise (and give) the pain meds on schedule instead of prn does she still get the same pain?

i thought Munchausen's was when a care taker makes a child or dependant sick. but i could be wrong as i don't know the syndrom other than what is on TV. and TV is not very often accurate

i thought Munchausen's was when a care taker makes a child or dependant sick.

There was a case of this (MSBP) years ago, which interested me so I followed it. They finally caught the mother by taking the child away and noting the child's immediate and dramatic health gains.

But in your case, in which you suspect the patient herself, there might be some privacy issues in installing cameras.

(Funny how you can sit and watch a patient 24/7 but if you let a camera do it, it's suddenly a privacy issue....)

Still Riding: Munchausen's by proxy is when the caretaker projects s/s onto another.

MJLRN, sounds like a psych eval & a visit by social services is LOOOOONG overdue.

Just b/c the pt is on medical assistance doesn't mean her meds are paid for. In IL, there is a list of meds that public aid will pay for & the doctors that accept aid are dwindling down b/c of the low reimbursement by the state. Definitely sounds like some major psych issues & drug dependency issues are at play here, but part of me has to wonder, if she is even seeing a primary care doctor for her uncontrolled diabetes. I am almost willing to bet that if her meds are covered by the state, she is selling them for cash to get narcotics. All these tests done & not one mention of a tox screen... I find that absolutely fascinating. Is her pain being treated with Demerol? Just curious...

i thought Munchausen's was when a care taker makes a child or dependant sick. but i could be wrong as i don't know the syndrom other than what is on TV. and TV is not very often accurate

You are absolutely correct, Munchausen syndrome by proxy (MSBP) is characterized when a parent physically causes their own child to be ill in order to gain attention to themselves, whereas Munchausen is when pt does it to self which could be the case presented.

From the case presented I get a bit of a personality d/o; somatoform disorder for sure, hypochondriasis, maybe, maybe not; most likely fictitious, but possibly psychosomatic.

Or it could be you old run of the mill psychosis.

Don't discount the fact that she may in fact have some underlying medical disorder that is causing these "strange" symptoms. I mean, she does in fact have abnormal labs and EKGs. These are kinda hard to fake. I would just caution you to not let your bias or belief that this is all psychological prevent her from getting good care. Much of what was said in the OP sounded judgemental to me.

I've seen this before and we discovered that the patient was having snickers bars, etc. brought in. It raised her blood sugars and the junk she was eating caused her GI distress.

You can be a hypochronic and have unlying physical problems at the same time she can be depressed and seeking attention and playing her physical sx for all thely are worth...she does need a psyche and a physical eval...

Thanx for the clearing it up.

You have all made good points, and I thank you for your responses. I apologize if my post sounded judgmental; I don't mean to be, but when you live in a small city with a disproportionately large population of females in their 30s and 40s with ongoing complaints of abdominal pain---for which every test possible is done and no cause is ever found---you tend to become a little jaded.

Don't get me wrong: My personal feelings don't change the way I care for patients. I take good care of everyone, and these ladies are treated just as courteously as anyone else.....in fact, I go out of my way to make sure their pain is controlled as well as it possibly can be. I've never had a complaint about my care, so I must be doing something right.......but these patients are difficult to deal with, not to mention utterly impossible to like, and it is frustrating when you cannot even come close to meeting their needs.

This particular patient fascinates me, however, because she does have some obvious medical problems, e.g. her diabetes, and because her attention-seeking is so extreme. We've all had pts. who demand a lot of our time; but this girl seems to literally thrive on crisis........and if there isn't one happening, she'll create one.

About the tox screen.........that was the first thing I thought of, but her initial one was normal except for opiates and benzos, which was expected because she is on narcotics for her pain issues and Ativan for anxiety. They haven't drawn another one, and it might be interesting to suggest it in order to find out if she's been ingesting something that could cause the transient EKG changes and high blood sugars (I've never seen any sweets in her room, and she receives controlled carbohydrate meals, but that doesn't mean anything).

The thing is, I really want to help this girl. She can be absolutely delightful at times, and she seems so lost and so frail.......having been through my share of misfortune when I was younger, I'm a sucker for people like this. But unless we can get to the bottom of what's really wrong with her, nothing we do for her medically will matter.......it's like putting a Band-aid on cancer.

Thanks again.

I have cared for a pt like this before and not only did she have munchausens, she had a boderline personality disorder......if you research you will find that boderline's know alot about medicine, medical terminology and disease processes, they make caring for them very difficult and often ER and doc hop.........Good luck p.s. my pt eventually signed herself out ama and was in another facility in 2 days ...