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Recognising deceptive patients

Hishani Dassanayake, LLB, Senior Solicitor, Avant Law, NSW

Monday, 22 February 2016

chest pain v2

Ms Burrows* presented to cardiologist Dr Pink complaining of chest pains. Dr Pink recommended an angiogram and warned Ms Burrows of the risk of groin complications and damage to arteries and veins.

The procedure was uneventful apart from a little bleeding afterwards which stopped once pressure was applied. Ms Burrows returned to see Dr Pink twice in the following weeks claiming she had sustained a bruise at the puncture site and was feeling uncomfortable.

On both occasions, Ms Burrows walked normally into Dr Pink’s surgery and made no complaint of weakness or any other neurological symptoms. Dr Pink requested Ms Burrows to have an ultrasound on each occasion. They showed a small haematoma but were otherwise normal. Dr Pink assured Ms Burrows that she would recover.

A couple of years later Ms Burrows sued Dr Pink for personal injury damages alleging that he had negligently punctured her femoral nerve causing femoral nerve palsy.

The case highlights important tips on how doctors can minimise the risk of a claim if a patient is exaggerating an injury or condition for a specific purpose, such as financial gain.

A very convincing story

Ms Burrows complained of various significant symptoms. Her case relied primarily on an MRI conducted two years after the angiogram. An expert organised by her solicitor said the MRI showed the damage could only have been caused by direct trauma to the nerve as the haematoma itself was too small to cause nerve damage.

Her solicitor also arranged assessments from other reputable experts who found she was severely disabled and required a walking stick. They supported her allegation of a femoral nerve palsy. A psychiatrist indicated she had a major depression.

Challenging the claim

An MRI alone is not diagnostic or conclusive evidence of such an injury and Ms Burrows’ clinical picture in the weeks following the angiogram had not indicated a femoral nerve palsy.

Avant engaged a neurologist who recommended an electromyography (EMG) – the only objective, diagnostic test to determine whether denervation had occurred. Ms Burrows refused to have an EMG and would not give a reason.

Suspicious of this refusal, Avant organised surveillance of Ms Burrows which clearly showed she could walk unaided and unrestricted. Ms Burrows ultimately agreed to a verdict in favour of Dr Pink.

Recognising a deceptive patient

Patients will sometimes shop around until they find a doctor to support their case and can be very convincing with their stories. This can make it difficult to recognise a patient who is exaggerating an injury or condition for a purpose such as obtaining schedule 8 medications or financial compensation.

Doctors can minimise their risk by being proactive and clearly documenting the circumstances surrounding a patient’s presentation:

  • Consider whether the clinical picture supports the patient’s complaint and check with other health practitioners if they had noted any symptoms or complaints.
  • Check if there are inconsistencies in your patient’s complaints or with your investigations or findings.
  • Consult a colleague for a second opinion (without identifying the patient).
  • Before any procedure, document the consent process to confirm that all common or serious risks of the procedure have been discussed and understood.
  • Keep comprehensive records of any follow-up visits and tests ordered.

If you are suspicious that a patient may be acting deceptively, or if you receive a demand for compensation, call Avant’s Medico-legal Advisory Service on 1800 128 268.

* All names have been changed to protect privacy.

Learn more: Avant Risk IQ

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Read our fact sheets, Difficult doctor-patient relationships and Dealing with patient complaints.

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