A case study in the American Journal of Medicine poses a vexing question many healthcare professionals have faced: What should you do when your patients use fraudulent names?
Here's :
"Mr. M. was a homeless 43-year-old male with a history of chronic pancreatitis who presented with gastrointestinal complaints. He also reported that he carried a diagnosis of lymphoma. Review of his prior records revealed a computed tomography (CT) scan showing enlarged lymph nodes. A prior excisional biopsy had showed a reactive lymph node. When questioned, he initially reported he was diagnosed with lymphoma at an out-of-state center after an excisional biopsy of another lymph node. He denied having any further records or details. Eventually, when pressed further for details, he admitted that the second biopsy was actually done at a local hospital under a different name -- Mr. K. He then proceeded to produce discharge papers under the alleged name. The discharge papers confirmed his allegations."
As , and colleagues at the Indiana University School of Medicine note, the "use of aliases and false names in medicine is not uncommon." Such behavior may be the result of a neuropsychiatric condition, or may be motivated, as the authors believe was true in this case, by secondary gains such as shelter and opiates. (It's also possible that a patient who is in the country illegally .)
The authors recommend "probing for secondary gain and/or a stressor that maybe causing this behavior" and "minimizing diagnostics to sensitive tests that have not already been done."
Have you seen this in the clinic? What did you do?