March 10, 2008

Munchausen by proxy

I first learned about Munchausen syndrome by proxy through the movie Sixth Sense, where young Cole conquers his fears and learns why he is being haunted. A young girl shows him a videotape revealing that her mother intentionally poisoned her to keep her sick! WTF?!? People really do that?!? I felt ill. It was totally outside of my realm of comprehension. In our last Unit on Neurology and the Musculoskeletal system, one tutorial group had a running gag when they hypothesized about the diagnoses for the cases: ascending paralysis? Munchausens. bouts of mania and depression? Munchausens. kids having trouble walking? Munchausens by proxy. headache? I think you get the point.

Browsing through my blog reader today, I came across this:
A Redlands mother of four was accused of Munchausen syndrome by proxy, fabricating or inducing illnesses in her own children
-LA Times, via the Lone Coyote @ Medical Student Musings

It certainly must be frustrating to deal with hypochondriacs... even more so with hypervigilant parents! Every little cough or sniffle becomes a sign of some impending disaster to the point where the doctors become desensitized to the Truth. Just because someone is seeking attention for a medical illness that they read about on the internet doesn't mean that they are Attention-Seeking and worthy of only a cursory exam and subsequent dismissal.

Perhaps this is just my naivete and inexperience speaking, but the patients with the irritatingly vague and persistent complaints may just BE the ones who deserve the most attention and cognition. Maybe, just maybe, they have a genetic condition like Ehlers-Danlos Plus (though I couldn't find it definitively on OMIM) with a chiari malformations that could explain the seizures, centralized sleep apnea and joint dislocations.

1 comment:

  1. As a patient with Chiari One Malformation who read the same article, I have to say munchausens is a misdiagnosis of anyone with Chiari One Malformation. And the article did say that the one kid did have a sphinx which by the way is usually the only reason any neurosureon in his right mind would operate on Cm1 patient. Symptoms are always vague and usually discounted as somethign else in Chiari patients and the biggest reason for it is because the CM patients pass the basic neuro exam that excludes the balance testing that should always be done. It doesn't cost a cent to watch a patient walk or to do the romberg test yet the first time I ever had those two tests done was after becoming a part of a clinical study in hopes to avoid surgery (unfornately I ended up needing surgery more than anyone) for chiari one malformation. My family still treats me like a hypochondriac by saying now everything is Chiari when in fact everything they complain about me can be checked off on a chiari survey but stuff like my infrequent headaches I know are not chiari because they are temple headaches and they are usually relieved by calming down (from the stress ones) or by having my glasses redone (For some reason my glasses need changing less than every year according to the optomitrist but I don't usually see them that often). My point is Doctors need to stop jumping to Munchausens when they hear hoofbeats in central park and can't find the horse. It's not a women painting a horse black stripes its a zebra.