Day 723

Cortex

I had my first real encounter with a patient who was clearly faking his illness today. There is a little loss of innocence involved with an experience like this I think because it proves that you can’t always believe patients 100% of the time like you hope you can. But don’t think I am getting jaded in a new way now. Probably the biggest thing I learned today is that these situations are quite complicated. As my attending emphasized emphatically this morning to all the residents and myself, psychogenic illness is the very last diagnosis you explore. It is a diagnosis of total exclusion. The problem is, people with mental illness get sick too and you have to be able to figure out the biological illnesses from the fictitious ones. You could have a boy who cried wolf scenario but the guilt will be with you if the boy gets eaten by the wolf. So of course myself, two residents, and the attending all conducted as thorough exams as possible on this guy. We ended up just diagnosing him with a complicated headache by default. Not the stroke he was going for but he still got treated.

I ended up not having to do the neuro exam in front of my attending today. I think because we were a bit rushed for time during rounds.

When I thought about our possible stroke patient later, I still felt bad for the guy. Not for his “illness” but for his being in a situation in which he felt that being a person with stroke like symptoms was better than being his relatively healthy self. I don’t know how a person gets to a place like that but I’m pretty sure it’s not an enjoyable journey.