Conversion d/o is a medical dilemma. Per DSM IV:”One or more symptoms or deficits are present that affect voluntary motor or sensory function suggestive of a neurologic or other general medical condition” with no known physical cause. In plain English:People present to the ER w/ neurologic complaints (seizures, loss of vision or hearing, lack of sensation in their legs, etc) and after a battery of tests to rule out the really bad stuff like epilepsy, stroke, brain cancer or infection… turns out that the patient is just full of shit.
I’m the kind of guy who really values his time. That Mario Kart Wii isn’t going to play itself. NTM that the workup can be brutal: spinal tap, brain/spine CT and/or MRI, EEG or even nerve conduction tests in addition to all the blood work. The bill for these guys is easily worth a Toyota Prius, and probably a mid-level BMW.
When someone goes to the ER you have to give them the benefit of the doubt that they’re not faking douchebags and take every symptom seriously. But it gets tiring to see 32y/o healthy women come in complaining of “numbness in my left pinky finger” for 3 days.
My friend
Dr. Chillburn developed a great method of separating the fakers from the truly ill. Ms X., A 35 y/o Hispanic woman admitted for seizures, was wheeled back to her room after a brain MRI. Chillburn looked at the prelim report w/ me. “Goddamn it! Everything is normal! She’s fucking faking I tell you!” He lamented, paging through The New England Journal of Medicine.“Yeah, but whatta you gonna do? You can’t just tell someone, ‘Sorry, but you’re crazy and you need a shrink and to stop wasting limited resources that could otherwise be used to help sincerely sick people ?’ That’s not going to fly,” I reasoned. Just then we were hammer-paged by the nurse caring for Ms. X.
“She’s having her seizures again, Doctor!” The nurse explained, with urgency in her voice.
“Ok, let’s get her on her side. I need oxygen and Ativan…let’s do rainbow labs and…” I started the usual grocery list of seizure protocol. Ms. X was writhing around like when Arnold is exposed to the Martian surface during Total Recall.
Dr. Chillburn calmly rolled up his copy of the Journal and emphatically smac
ked Ms. X across the face w/ it. “NO….. Stop it!! You don’t have epilepsy and you don’t have seizures! This is ridiculous!” Her eyes got big and her jaw was agape. She was shocked and appalled… and she was cured. Ms. X stopped her convulsions immediately. I wonder how much Medicaid will let us bill for that treatment plan?
2 comments:
Nice - sometimes you may even find a psychiatrist do that. A friend of mine who is a psychiatry resident was on call one night didn't have time to mess with the pseudo seizures a patient was giving him. So, when she was "seizing" he opened her eyes and said, "Listen, I don't have time for this. Stop faking your seizures, I have other things I need to do." And she stopped!
I should write up a grant proposal and test these methods in a more controlled environment.... like Cook County, er, I mean "Stroger", bleh!
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