Earlier this week I posted about a patient who was malingering. This post is similar, but more disturbing. As with all the stories I post here, I changed enough of the details to keep identities private.
I took care of an 18 year old boy named Tom. His mother, Martha, brought him in for his ongoing chronic condition. She claimed that he had been sick since birth. He had several implanted tubes to manage his condition including two types of feeding tubes and a central line. He had not taken oral nutrition in years. Instead he received all of his nutrition through his central intravenous line, a dangerous, expensive treatment. He also seemed to be developmentally delayed. He had volumes of medical records that were scanned into our e-chart system and Martha also kept a binder of medical records at the bedside.
As our physicians got to know Tom, Martha, and the tome of medical records, they began to find inconsistencies in the chart. Soon, all the tests they ran on Tom came back saying that Tom was fine. The physician continued to dig. The chart included a letter from a physician stating that Tom was on a transplant list in a neighboring state. The shrewd physician dug a little deeper. He eventually discovered that the letter was a complete forgery. Our physician contacted the out of state physician who had never heard of Tom or Martha.
While I’d seen patients play up their symptoms, what was going on here was much more disturbing. This condition is called Munchausen Syndrome by Proxy. It is a serious psychological disorder and form of child abuse. Caregivers fabricate symptoms and episodes for secondary gain, perhaps attention or other perceived benefit. Tom had gone through endless tests and procedures, any one of which could have harmed or killed him. The fact that he was young and developmentally delayed made him very vulnerable. The physician referred the patient to psychiatric services and I really hope they both got the help they needed. It unknown how many children are harmed by Munchausen Syndrome by Proxy. It is thought to be uncommon and hopefully most caregivers don’t get as far as Martha did.