Problems of deception in medical practice

The MMPI-2 Symptom Validity Scale (FBS) Not Influenced by Medical Impairment: A Large Sleep Center Investigation

The Symptom Validity Scale (Minnesota Multiphasic Personality Inventory—2—FBS [MMPI-2-FBS]) is a standard MMPI-2 validity scale measuring overstatement of somatic distress and subjective disability. Some critics assert the MMPI-2-FBS misclassifies too many medically impaired persons as malingering symptoms. This study tests the assertion of malingering misclassification with a large sample of 345 medical inpatients undergoing sleep studies that standardly included MMPI-2 testing. The variables included standard MMPI-2 validity scales (Lie Scale [L], Infrequency Scale [F], K-Correction [K]; FBS), objective medical data (e.g., body mass index, pulse oximetry), and polysomnographic scores (e.g., apnea/hypopnea index). The results showed the FBS had no substantial or unique association with medical/sleep variables, produced false positive rates <20% (median = 9, range = 4-11), and male inpatients showed marginally higher failure rates than females. The MMPI-2-FBS appears to have acceptable specificity, because it did not misclassify as biased responders those medical patients with sleep problems, male or female, with primary gain only (reducing sickness). Medical impairment does not appear to be a major influence on deviant MMPI-2-FBS scores.

Playing patient, playing doctor: Munchausen syndrome, clinical S/M, and ruptures of medical power

This article deploys sadomasochism as a framework for understanding medical practice on an institutional level. By examining the case of the factitious illness Munchausen syndrome, this article analyzes the operations of power in the doctor-patient relationship through the trope of role-playing. Because Munchausen syndrome causes a disruption to the dyadic relationship between physicians and patients, a lens of sadomasochism highlights dynamics of power in medical practice that are often obscured in everyday practice. Specifically, this article illustrates how classification and diagnosis are concrete manifestations of the mobilization of medical power.

Compulsory treatment for anorexia nervosa: compassion or coercion?

Compulsory treatment for anorexia nervosa was recently once again a topic for discussion following the case of J, a 16-year-old girl who unsuccessfully applied to the Court of Appeal to refuse treatment for her anorexia nervosa. In this instance legal opinion was sought in order to clarify the Children Act 1989. However, much of the media coverage focused on the controversy surrounding the compulsory treatment of anorexia nervosa, under the provisions of the Mental Health Act 1983. There is a lack of research into the compulsory treatment of anorexia nervosa, so debate has to be informed by clinical experience.

Predicting disability time using formal low back pain measurement: the Low Back Pain Simulation Scale

Objective evaluation of simulation in low back pain is currently not possible. A new simulation scale based on subject response to 103 pain words has shown promise in discriminating patients with low back pain from those simulating low back pain. Administration of this scale to 1679 individuals who were injured at work produced a 10.4% sample with scores in the simulation range. This subsample projected more intense pain and were disabled longer. These findings were replicated in a second study in which treating physicians rated the degree of physical pathology and symptom exaggeration blind to patient classification by the Low Back Pain Simulation Scale. Medical assessment indicated less organic pathology and greater symptom exaggeration among patients classified as simulators providing a measure of support for the validity of the simulation scale.

Temporary Munchausen syndrome

Over 14 years a patient was admitted at least 91 times to at least 25 general and four psychiatric hospitals and treated for a wide range of conditions that she did not have. She appears to have recovered. The medical and psychiatric care she received probably contributed to the onset of this disorder in a person already vulnerable, and to its maintenance.

Hysteria, belief, and magic

“We cannot command nature except by obeying her” (Bacon)

Dermatitis artefacta induced in a patient by one of her multiple personalities

A young woman suffered for 5 weeks with an inexplicable, severe dermatitis limited to her left arm. During hospitalization it was found that she had multiple personalities, one of whom had been applying the leaves of the poison ivy plant each night to her left arm, using 'his' gloved right hand. The factitial nature of the dermatitis was further documented by the fact that when the 'responsible personality' was cut off from supplies of poison ivy in the hospital, 'he' produced factitious haematomas by trauma to her left hand. Although this appears to be the first report of dermatitis artefacta associated with the multiple personality disorder, it is suggested that psychiatric study of other dermatitis artefacta patients might reveal the presence of unsuspected occult multiple personalities, responsible for skin lesions that patients cannot explain.

Dermatological games

Doctor/patient relationships may not be optimal in medicine in general and in dermatology in particular. The study of the dermatological consultation has been entirely neglected and game analysis may form a useful basis for further study. It is not possible to know whether better communication with patients leads to better responses to treatment, but there is no doubt that better communication leads to better patient compliance with regard to therapy. There are many dermatological games. An insight into these games may not only improve doctor/patient communication, but also make the consultation a much more interesting event for the dermatologist. Once the processes involved in the consultation are understood, the way is open for improvements. The dermatologist should become as interested in the art of practice as he is knowledgeable in the science and clinical features of dermatology.