Well, after all the talk of "professionalism"...
Mr. G was a 45 year old who presented last week to the ED. He's a rather unpleasant guy with over 50 prior ED visits and multiple notes in his chart about being "uncooperative" and "noncompliant". We were consulted because he complained of right arm tingling and weakness that was present when we examined him, but mysteriously disappeared when we left the room. His exam was nonfocal (neuro code for "nothing wrong").
There was nothing else in the history that would have clued you in to any diagnosis, except his abuse of the emergency room. No trauma, no vascular disease, nothing. He's a deadbeat dad who is currently remiss on his child support (recently documented on his chart). He hinted that he's currently homeless. In the hospital he gets a warm bed and free meals.
This guy is faking it.
We still ordered an MRI of the head to rule out the slim possibility of stroke - only to find that he actually crawled out of the MRI machine, yelling at the tech that he was uncomfortable. We finally convinced him to get the MRI, and on a whim, got images all the way down his neck. Just in case.
- Radiology Report -
MRI Head : normal, no stroke seen.
MRI Neck : acutely herniated C5, C6 disks impinging on the right neural foramina. Correlates anatomically with pattern of right arm weakness and tingling.