Medical Care
Do not accuse the patient directly of faking an illness. Hostility, breakdown of the doctor-patient relationship, lawsuit against the doctor, and, rarely, violence may result.
The more advisable approach is to confront the person indirectly by remarking that the objective findings do not meet the physician's objective criteria for diagnosis. Allow the person who is malingering the opportunity to save face.
Alternatively, the physician may inform people who are malingering that they are required to undergo invasive testing and uncomfortable treatments (provided, of course, that such warning is true).
Invasive diagnostic maneuvers do more harm than good. Hospitalization is almost never indicated since individuals intend no harm to themselves and a hospital stay rewards the undesirable behavior.
The likelihood of success with such approaches is inversely related to the rewards for the malingering behavior. [4, 16, 17, 9]
Consultations
People who malinger almost never accept psychiatric referral, and the success of such consultations is minimal. Avoid consultations to other medical specialists because such referrals only perpetuate malingering. However, in cases of serious uncertainty about the presence of genuine psychiatric illness, suggest psychiatric consultation.
Psychiatric consultation may be suggested as an augmentation to dealing with an acknowledged symptom. For example, the primary physician might propose, "Your pain has to be causing your system a great deal of stress, and we know that only makes the pain worse. Consultation from a psychiatrist might help us with your pain by reducing the stress." Without being confrontational, the physician must remain honest. [18, 17, 9]
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Diagnostic algorithm for suspicious symptoms.
