Acute Thespian Syndrome

(The sudden need to fake an illness.) In medicine we learn to ask questions and to believe the answers. Even when things don't seem to make sense, we error more on believing the patients. The problem are those patients with Acute Thesbian Syndrome. These are those wonderful citizens who are on their way to jail who sudden have chest pain, or mind splitting headaches with neck stiffness, or the classic sudden abdominal pain. My favorite was the women who claimed that she was in premature labor (fat dont make you pregnant). Their goal is that the police will bring them to the hospital, and leave them there instead of pressing charges. The police will often do this so that they dont get stuck with the bill or for minor offenses they just cite the person and hope that they will show up in court. The patients know that there will be tests ordered and as long as they keep complaining the work up will continue until the police lose interest. The "patient" then suddenly gets better and then is discharged or leaves AMA. It is amazing how good patients can fake chest pain after watching "ER"! This weekend was no exception. We had several cases of ATS. The good ones know to complain of severe pain in the hardest areas to evaluate such as deep in the pelvis or abdomen. Several were in with severe kidney pain from stones. We have to have several people watch them pee into a cup to keep them from picking a scab and dripping blood into it. They not only wanted the police to leave them but were hoping for some narcs. One patient with ATS this weekend had severe vomiting. We were lucky that the radilogy tech saw him taking ipecac when he went behind the screen to set up the abdominal film.

Acute Thesbian Syndrome is also a good way to get out of jail or prison for a few days and enjoy cable and the presence of nurses of the opposite sex. The prisoners know that the best way to do this and to help their cause is to fake a psychiatric illness. They parlay this into getting out of jail for a time and then use it as an excuse for their criminal behavior in future parole hearings. We catch them with our "patient safety cameras" in sudden lapses of normality.

I wish we could be like those stores that have signs and lists that say "We do not take checks from these people". Ours could be "We do not take chest pain from these people!"