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One of the more challenging and amusing aspects of family practice involves illness by proxy. It is something rarely witnessed in the emergency department or walk-in clinic. I suppose that it is an off-shoot of our busy society and reflects the time stress that we can find ourselves under.
Much of illness by proxy involves husbands and boyfriends. During such encounters, the “proxy” patient books into the office and usually arrives late. An illness by proxy encounter is one of the most difficult to book. It requires suave skills of persuasion to convince the receptionist that the emergency squeeze-in spot is deserving of such honor.
The illness by proxy encounter is sure to take place later in the day when the office is backed up. It begins with a well rehearsed but familiar proclamation of how the patient is really not there for themselves. Instead they have been sent on a mission by someone to test my skills of diagnosis of the random and never seen. It may involve a husband whom I may have met a decade earlier, a relative who is too busy to visit the doctor, or the ultimate challenge, a complete stranger.
The newbie to proxy-illness usually tests my skills of rashes or foot ailments. “His feet hurt because he stands on them and he needs orthotics, support stockings and a lumbar support.” as they cleverly pull out a form kept hidden from the receptionist. I am politely informed that signing the blank form will unlock a universe of good and just things for the unseen friend.
Most admit that they would not buy any of this stuff if they had to ante-up the money themselves. I actually sat down and read one. The forms usually start by stating that the company handing you the form, expects you to pay for it all and sign away your confidentiality. This is followed by the details of abnormalities found on the absent patient.
Not having the slightest idea of what the proxy patient looks like seems to be a trivial formality. This is why most doctors hate forms. When companies force patients to pay for these documents, doctors will almost always sympathize with the plight of their patient who usually gets the last laugh.
Another form of proxy-illness involves rashes and minor ailments in absent patients. “My boyfriend is all itchy and red. What do you think it is, doc?” Some even reach for their cell phones and insist that I converse with the phantom patient. Experience quickly tells me to decline such traps. Past calls had people informing me how they have never met me, deplore wasting health care dollars by visiting doctors and go on to relay to me a useless description of their groin or some such. I try to be as professional and helpful as I can in formulating my reply, and suggest they send in a different friend for a second opinion.
Other types of proxy-illness involve second opinions on hospitalized distant relatives, assumptions that my “computer” is all-knowing about opinions received in other clinics, countries and universes.
It was recently pointed out to me that soap-opera doctors who only see one patient a day, freely comment on all types of subjects. They also have rapid diagnostics with no line-ups, amazing readily available cures and dashing colleagues in Armani suits sipping cappaccinos whilst intellectually conversing about unknown medical breakthroughs and offering second opinions on fashion and marital distress. But most surprising is that proxy-illness is not OHIP-covered and neither is House!
● Factitious discorder from Wikipedia, the free encyclopedia.
● Münchausen syndrome from Wikipedia, the free encyclopedia. "Münchausen syndrome is a term for psychiatric disorders known as factitious disorders wherein those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome. Nurses sometimes refer to them as frequent flyers, because they return to the hospital just like frequent flyers return to the airport."
● Münchausen syndrome by proxy.
● Munchausen Syndrome by Proxy - Topic Overview from WebMD.
● Factitious Illness By Proxy - Where are we now? Julia Macur QC reviews the use of terms such as 'factitious illness by proxy' at fact finding hearings in the light of recent cases.
● Malingering from Wikipedia, the free encyclopedia.
● Attachment representations in mothers with abnormal illness behaviour by proxy by Gwen Adshead, MBBS, FRCPsych, and Kerry Bluglass, MD, FRCPsych. Royal College of Psychiatrists. British Journal of Psychiatry (2005) 187: 328-333.
● My husband has terrible mood swings. Is it illness or is it our relationship?
● Help! My husband won’t go to the doctor!
● My Boyfriend has Been Sick, And He Won't Go To The Doctor.