While I give patients the benefit of the doubt that they would not be intentionally faking a voice disorder, there are times when after initially correcting a nonorganic voice disorder, and pointing out to the patient all her inconsistencies, the problem persists. The patient clearly has the ability to correct her voice problem and does not. Usually with inappropriate persistence of a condition, the secondary gain becomes obvious to the examiner. Perhaps the partner’s additional attention that is present during the disorder, a monetary reward for remaining ill, or some other gain misaligns with the patient’s incentive to recover.
Not always, but often enough, a patient will have a history of multiple other, somewhat ill-defined disorders (often also nonorganic) in other parts of her body. One of the reasons I correspond with all physicians involved in the care of the nonorganic patient is to alert other caregivers, raising their suspicion about any medical problems that are inconsistent with typical illnesses. Otherwise, patients with nonorganic conditions tend to gravitate to the physician who gives the most treatment. Not infrequently, since the patient is not responding in the usual manner, the physician administers stronger and stronger treatments and the patient begins experiencing actual organic side-effects from her medical or surgical treatments.
Not infrequently, since the patient is not responding in the usual manner, the physician administers stronger and stronger treatments — and the patient begins experiencing actual organic side-effects from her medical or surgical treatments.
What You Learned
- Malingering is distinguished from other nonorganic disorders by its persistence after the patient has been shown their own normal voice production and the inconsistencies have been pointed out.
- The secondary gain in malingering is usually apparent to the examiner — financial incentive, a partner’s attention, or avoidance of obligation.
- Corresponding with all treating physicians alerts caregivers to inconsistencies and prevents patients from gravitating toward those who offer the most treatment.
- Unchecked, escalating treatment for a nonorganic condition can produce real organic harm — the treatments themselves become the disease.