What Is Our Ethical Duty to Malingerers?: Page 3 of 3
Many geriatricians are unaccustomed to encountering the kind of behavior exhibited by the case patient. When a provider performs a pain assessment (the “fifth vital sign”) based on common guidelines for the management of pain in older adults, there is a general rule that we should always believe our patient’s subjective reporting of pain. Our patient’s case illustrates a need for skepticism and caution when a psychiatric comorbidity is present. Personality disorders often abate in age, but not uniformly nor absolutely; thus, the possibility of malingering is not excluded in the geriatric patient population.
Thought leaders promulgate an interdisciplinary team approach when caring for difficult patients. We used such an approach to care for the case patient. While this approach enabled us to properly assess his physical and mental condition, enact a unified policy regarding his therapeutic regimen, and place limits on his behavior while on the unit, it was not effective in treating his drug dependence or in altering his socially unacceptable behavior. Even effective interdisciplinary clinical teams function within one unit or facility and handle one patient encounter at a time. The case patient would require a large expansion of the concept of team-coordinated care—one that could stretch across multiple encounters and multiple institutions—to have any hope of impact.
Dr. Bishop is an advanced geriatric fellow, and Dr. Chau is program director, Geriatric Medicine Fellowship, University of Nevada School of Medicine, Reno, NV.
The authors report no relevant financial relationships.
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