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Updated 30 August 2018

How doctors can spot when you’re faking an illness

It's one thing to cough and sniff in front of your parents or boss, but you need to realise that it's a completely different matter to fake an illness to an actual doctor.

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Most of us have faked a cough and sniffle to get out of going to school or work for a day. However, it usually does not involve lying to a doctor and faking symptoms to legitimize your sick leave. 

Well for some of us it does. According to a previous Health24 article, an employer can request a medical certificate if an employee has been absent from work for more than two consecutive days – in other words, from the third day onwards. 

When a medical certificate is required and you do not have one, it might seem like the only option to lie to your doctor in order to get that medical certificate. However, your doctor will probably see right through your scam. 

The illnesses faked the most 

Health24 spoke to Dr Imraan Shaikh, a qualified general practitioner who has experience working at family practices, tertiary hospitals, trauma centres and a children’s hospital.

According to Dr Shaikh, the conditions faked the most are headaches, gastrointestinal issues such as diarrhoea and back pain.

On a reddit thread entitled Doctors/nurses of Reddit; What is the most obvious case of a patient 'faking it' you have ever seen? there are thousands of comments from doctors, paramedics and nurses sharing encounters they have had with people who have faked an illness or two. 

While the thread contains various ailments faked by people, one that seems to be popular among fakers are seizures, which ironically are the easiest to spot when being faked. 

What doctors look for 

Dr Shaikh explained that "the signs that we have used are not many as each individual is unique in their presentation of the said ‘fake’ ailment."

However, according to Dr Shaikh, these are some of the signs that stand out more than others:

  • Over-exaggerating of symptoms that are not correlating with the clinical picture and history that is being told. "This is a suspicious sign", according to Dr Shaikh. 
  • A patient that refuses certain medications/procedures that would otherwise benefit the ailments of which she/he complains of. A good example of this are blood tests to rule out other causes.
  • The illness is usually a condition that can neither be confirmed nor denied by the medical practitioner based on the 15–20 min consultation that a patient has with him/her. Dr Shaikh explained, "This would mean that the history for the condition has to be the deciding factor and the examination just serves to decide if the patient is to be admitted to hospital or not, or the severity of the illness described."
  • A sick certificate around public holidays or long weekends is often very suspicious.
  • Repeat offenders are very common. Once a patient has gotten away with an activity that would be deemed suspicious in this regard, chances are they will be back in the not-too-distant future.
  • Illness is not a difficult thing to fake if one knows the symptoms. However, your body cannot lie and once a patient has been deemed suspicious of faking an illness, they will always be under the medical doctors radar. Most doctors know about this and if rapport is good with the patient, eventually will confront the patient about it.
  • Asking for more days to be added-on to the already initiated medical certificate always renders suspicion.    

Health24 also spoke to Dr van Deventer, a qualified doctor who practiced as a GP in the Northern Suburbs of Cape Town and is currently working in Khayelitsha doing Paediatric TB Research.

"One of the telltale signs is that the complaints of the patient will be very vague," explains Dr Van Deventer. "They won't have specific problems and won't be able to specify exactly when symptoms started – more like 'a vague feeling of not being okay' and that they 'can't really put their finger on it'." 

The faker may also go a little too far with their charade, which will raise further suspicion. As Dr van Deventer puts it, "The other side of the coin is when they claim to have very severe symptoms. They come in coughing their lungs out, but when you listen to their chest, there is nothing wrong." 

It should be obvious to a person faking an illness that it would be difficult to make your "symptoms" verifiable through a stethoscope or a blood pressure meter. Dr van Deventer further explains, "The severity of the 'symptoms' would not match the findings of the clinical examination." 

Image credit: iStock 

 
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