What Doctors Mean When They Say “Sick”
How do we know if a patient is sick?
Often times we talk about “Physician Gestalt” – the overall feel of how the patient is presenting, possible diagnosis, sick vs not-sick, real vs not real etc.
ER doctors are the EXPERTS at this, but we often treat patients that we think are “faking” the same as patients that we think are “real”. This is because we don’t want to miss something serious. We can generally spot the difference between “real” and “faking” patients. We see thousands of patients and often times they fall into several general categories. Some may be very severe, and others… just pretending.
These categories include:
- Sick – when an ER doctor says a person is “Sick”, this means they are actively experiencing a severe medical problem which could cause them to die if they don’t get immediate treatment. This could be a heart attack, appendicitis, bad pneumonia and many others. SICK MEANS BADNESS.
- Not-”sick” but with a real medical problem – these patients may have a small pneumonia, a mild flu-like illness, simple UTI etc. This is your regular patient with a real problem who isn’t dying but needs treatment.
- Patient who thinks they have something wrong but don’t – this category gets more complex. These patients may have an anxiety component. Think about all the times in life you had an ache or pain or weird feeling. This may have been caused by something but did not necessarily indicate an underlying disease process. These patients often need a workup, reassurance and good return precautions.
- For example, let’s say you have severe abdominal pain but no physical findings to suggest a cause. Well, this could still be caused by a disease that is harder to diagnose, in this case the patient would actually fall into category 2.
- Patients can also have symptoms caused by a psychiatric or stress related syndrome. These are still REAL syndromes but without a clear physical cause. You could consider dividing this category up on its own.
- Some patients have vague symptoms without a cause. In medicine we sometimes diagnose patients with a “disease” that is simply just a description of their symptoms. Examples include dyspepsia – which is basically indigestion, mastalgia – breast pain, dentalgia – tooth pain and MANY MORE.
- Patients who are ACTIVELY FAKING- these patients tend to be more rare. Patients in Category 3 are much more common. As an ER doctor, these patients are normally fairly easy to spot as they often have a motivation for faking. These motivations include: drug seeking, malingering (faking to get out of work or for some other gain), or faking for attention (Munchausen syndrome – although this is technically a legitimate psychiatric illness – you see how these categories start to blur together a little bit).
When to order a full workup
Often times, doctors will get a full workup on patients who they believe to be faking. This is because we can’t be sure that the patient is faking until we get the workup. This leads to frustration for many doctors as this is often times seen as a waste of resources.