So, what do you do when a patient fakes it?
I don't come across a lot of patients who knowingly exaggerate their symptoms or capitalize on their own injuries for other reasons. Most of my patients are well intentioned and hard working in regaining their function and mobility.
I was working with a patient today who had a history of psychological disorders and was avoiding placement at an inpatient psych facility. For several reasons, the patient used his "intolerable pain" to maximize his time in the hospital and thereby postpone his discharge. I have always been in the mindset at work that I am providing great care to patients who need and appreciate my time, so I was caught completely off-guard by the patient's presentation.
One of my internships in school included a 90% workers-compensation caseload. There was a higher volume of patients abusing therapy privileges than my current clinical setting, but also more doctors and case managers involved in preventing and stopping therapy services for those individuals. Since many of the patients diagnoses included low back pain, sprained ankles, carpal tunnel and knee injuries, my instructor taught me to start many of the evaluations by reminding the patient of the usual timeline for recovery. By setting an expectation early in our patient-therapist relationship, we were able to hold our patients accountable.
Especially as new health care laws are proposed and signed, it's important for us as providers to prohibit patients from abusing the system. Easier said than done.