Author Topic: How do deal with someone you know is faking being HIV +? (Read 10310 times)

Coffeechick88 · « **on:** December 20, 2006, 05:56:32 pm »

Well, the title is self explanatory. There is the this guy who I met a while ago who is one of our frequent flyers in ER and comes as an outpatient. He always talks about how he has found out he has HIV and Hep C about 2 years ago. The problem is, I know he doesn't have either one of those. He usually likes to come when I'm around--maybe because I don't know a lot of people who have HIV and not a lot who really can relate to me, and I was nice to him for that reason (didn't disclose my status to him) and paid attention to him--anyway, he usually comes when I am working. They always order the HIV and Hep C tests and a few times a CD4, so basically he asks for me to draw his blood and I also am the tech, so I perform the tests. The thing is, he is always negative. He doesn't have any conditions that make him immunosupressed and he has CD4 1000 to >1500 and every test for Hep C, HIV, viral load for HepC and HIV all negative. I have tried to distance myself and stay professional to him, and since HIPAA is there, I cannot tell him that I perform his labwork and I know that he is full of shit. I definitely think he has mental issues going on as well. Anyhow, he is well known and everyone who works with him hears him talk on and on about his HIV and Hep C, though not everyone knows it just isn't the case--a few do though. It's just he has taken a liking to me and I am not sure how to make him go away. It is common for patients to like certain people to draw their blood and wait on them and such, but I feel that I am partly to blame for him keeping up his charade. Is there a way to deal with this without letting him know that I am on to him, since I cannot legally do that anyway?

Cliff · « **Reply #1 on:** December 20, 2006, 06:00:42 pm »

just do your job, if he wants to walk around pretending to have HIV that's his problem. If a few people know, it sounds like he won't have too many chances to fake it anymore. People gossip. Like wildfires.

I wouldn't worry about it and I would not change how you interact with him (strictly professional). He may be the suing type.

Longislander · « **Reply #2 on:** December 20, 2006, 06:01:22 pm »

maybe next visit, you can have a Dr talk to him

aupointillimite · « **Reply #3 on:** December 20, 2006, 06:04:18 pm »

More than likely, he's got Munchausen syndrome. The bane of the medical profession...

The only thing you can do with those people is refer them to a therapist.

Doctors can't stand these people because they needlessly take resources from an already strained system...

newt · « **Reply #4 on:** December 20, 2006, 06:06:30 pm »

Refer him to a leukaemia specialist

Coffeechick88 · « **Reply #5 on:** December 20, 2006, 06:07:03 pm »

I think more people may be figuring it out. I definitely can't talk about it--HIPAA and all and I don't start gossip since that is not something I'd want to do to me. I just hope if I distance myself such as have someone else go draw him and not drop everything to go to him and be just professional and only draw him if I am not busy, as if I am not obviously changing things, hopefully it will work. It just makes me so uncomfortable to go along with this--the guy needs help, but again I cannot be the one to suggest that to him. Sigh, I just tend to let people involve me too much in their problems! If only I was good at being professionally distant--precisely the reason I have gone in the lab profession and research and such and not more patient oriented jobs.

Coffeechick88 · « **Reply #6 on:** December 20, 2006, 06:09:43 pm »

Quote from: aupointillimite on December 20, 2006, 06:04:18 pm

More than likely, he's got Munchausen syndrome. The bane of the medical profession...

The only thing you can do with those people is refer them to a therapist.

Doctors can't stand these people because they needlessly take resources from an already strained system...

I definitely think that is what he has. The problem is he goes to different doctors. Sometimes he has an order from one of our infectious disease doctors, another from one of the clinics affiliated with the hospital, and then there is ER--where there may be a different doctor each time. Those who see him the most are the ones who realize it, but doctors don't always talk to each other so then each time his need for attention is fed.

Cliff · « **Reply #7 on:** December 20, 2006, 06:12:49 pm »

Buy HIPAA doesn't prevent you from referring him to a doctor based on what you know, does it? His medical records are still safe and confidential. A doctor/administrator who could check things out and ask that he seek mental health attention the next time he's in or perhaps ask him why he keeps testing for STDs so much, when they are always negative.

Miss Philicia · « **Reply #8 on:** December 20, 2006, 06:15:54 pm »

Odd behavior. I can only imagine what other things he does around town.

Coffeechick88 · « **Reply #9 on:** December 20, 2006, 06:17:05 pm »

Quote from: Cliff on December 20, 2006, 06:12:49 pm

Buy HIPAA doesn't prevent you from referring him to a doctor based on what you know, does it? His medical records are still safe and confidential. A doctor/administrator who could check things out and ask that he seek mental health attention the next time he's in or perhaps ask him why he keeps testing for STDs so much, when they are always negative.

Well, I think the main reason the tests are duplicated so much is the multiple doctors he always sees and if they do not know about the other doctors, they aren't on to him. I do not know if he even has one constant doctor. I will have to check with our privacy and compliance officer to see if there is anything I can do. They are sooo cautious about HIPAA--you can get in loads of trouble even if you accidently disclose something.

Cliff · « **Reply #10 on:** December 20, 2006, 06:19:20 pm »

Well be careful, but your compliance officer should know what to do. Good luck to you (and to him).

marco23 · « **Reply #11 on:** December 20, 2006, 06:21:49 pm »

You've gotten some excellent advice so my advice now is - TO SMACK THE SHIT OUT OF HIM! Well, it's a good thing you've had some posts with good sense and since they've done that, next time.........SMACK THE SHIT OUT OF HIM AGAIN AND WITH NO WITNESSES... oh, okay, well...it's a good thing you had some excellent advice before.

aupointillimite · « **Reply #12 on:** December 20, 2006, 06:22:03 pm »

Quote from: Coffeechick88 on December 20, 2006, 06:09:43 pm

Those who see him the most are the ones who realize it, but doctors don't always talk to each other so then each time his need for attention is fed.

They're also probably passing him off onto everyone else. They don't want to deal with him, and I can't say as I blame them.

Munchausen patients just go from doctor to doctor... practices can "fire" patients or refuse to see them for things like this, I believe.

thunter34 · « **Reply #13 on:** December 20, 2006, 06:23:38 pm »

I think that sound like the best call. This is a surreal read here! Seems that surely this needless waste could be stopped properly without breaking any codes. I will say that someone who acts like this DOES need some kind of attention...just not the kind he's getting this way.

Good luck!

Coffeechick88 · « **Reply #14 on:** December 20, 2006, 06:24:55 pm »

Quote from: marco23 on December 20, 2006, 06:21:49 pm

You've gotten some excellent advice so my advice now is - TO SMACK THE SHIT OUT OF HIM! Well, it's a good thing you've had some posts with good sense and since they've done that, next time.........SMACK THE SHIT OUT OF HIM AGAIN AND WITH NO WITNESSES... oh, okay, well...it's a good thing you had some excellent advice before.

hahaha. There you go. "Oh, why does he have that broken nose? He had that when he came to ER--they didn't write that on the chart, Doc?

??"

ChaplinGuy · « **Reply #15 on:** December 20, 2006, 06:27:44 pm »

This is sad, but I've witnessed it before with other diseases. In fact, I dated a girl in college who told everyone she has Hodgkins, only to find out (when she never showed any symptoms and claimed one day out of the blue she was "cured") she was making it up. I think for most who do this it's for attention - there is a real sense of community and belonging for some in here, so I can understand why people without a group or friends or family might cling to that.

It's symptomatic of a larger problem, and he needs to get help.

Alain · « **Reply #16 on:** December 20, 2006, 06:38:01 pm »

Don't get involved, this guy might be a lot sicker than you think he is.

If the front line people, doctors and nurses who have the ability to do something about it, don't

I would just leave it alone. Basically you are not to know.

Just me.

AustinWesley · « **Reply #17 on:** December 20, 2006, 06:57:53 pm »

Quote from: aupointillimite on December 20, 2006, 06:04:18 pm

More than likely, he's got Munchausen syndrome. The bane of the medical profession...

The only thing you can do with those people is refer them to a therapist.

Doctors can't stand these people because they needlessly take resources from an already strained system...

I agree with Beers!

Here's a link to Munchausen Syndrome: http://www.emedicine.com/emerg/topic322.htm

This guy clearly has mental issues and is taking advantage of the system. There have been bizarre cases where people have actually poisoned others for the attention they get. I would quietly alert whoever the intake people are and steer clear of this guy. He needs psychiatric help for sure!

jntmax39 · « **Reply #18 on:** December 20, 2006, 07:02:03 pm »

Wow that's sick,can't you red flag him like they do with addicts who abuse the system?

AustinWesley · « **Reply #19 on:** December 20, 2006, 07:04:57 pm »

Quote from: aupointillimite on December 20, 2006, 06:22:03 pm

They're also probably passing him off onto everyone else. They don't want to deal with him, and I can't say as I blame them.

Munchausen patients just go from doctor to doctor... practices can "fire" patients or refuse to see them for things like this, I believe.

Again Beers is correct. I used to work for a health insurance company for years. Occasionally, we'd run across claims from a paitient like this and get complaints from the various providers. From the insurance company's standpoint we were able to cancel some of these people from the plan if they failed to comply, whether it be to stop their behavior or fail to seek an independent psychiatirc specialist. One we had was really bizarre as he claimed he was in line as a transplant paitient. He managed to con several providers into believing this and the claims ran into the hundreds of thousands of dollars. Our fraud department was allerted, but because he was independently diagnosed with some form of muchausen's we were unable to cancel him. Ultimately, he ended up in prison as I recall for unrelated fraud and then the prison medical system took over.

Eldon · « **Reply #20 on:** December 20, 2006, 07:06:52 pm »

Hey Coffechick88...

In this situation, the best thing that you may want to do is refer him to a specialist of some kind. When he goes to the specialist, have them reveiw his current set of lab results with him.

"Don't Give Up, Don't Give In... Cause it is ALL within you to WIN!"

Oceanbeach · « **Reply #21 on:** December 20, 2006, 10:29:52 pm »

I had an uncle once who spent years trying to get on disability because he liked the attention he got with each and every possible disease. When A doctor told him there was nothing wrong with him, he went to another doctor. He once announced to the family that he had Hiv (not HIV but Hiv). He saw a headline in a newspaper. When some cousin told him how HIV was spread, he claimed the doctor made a mistake and searched for another doctor. He did this most of my life and never found out we called him Uncle Deadbeat.

When I was diagnosed with AIDS, I was put on Norvir. The doseage was 6 pills, three times each day. The pills were worse than the symptoms. I bet with a months supply of Norvir, your patient would go away. Have the best day
Michael

When Uncle Deadbeat died, the cousins put his ashes in place they would never forget.

AtomicA · « **Reply #22 on:** December 21, 2006, 01:12:56 am »

I don't know how this medical system bru-hah ha works, but is there even the slightest chance that he actually believes it? I mean he keeps coming in for these tests but who gives him the results? He'd have to be pretty freaking stupid to not think that the people drawing the blood and doing the testing would never figure it out... telling your friends and family you have HIV for the whole drama and sympathy of it is one thing but telling the medical community - the one group of people who can clearly call you on your bullshit - sounds really REALLY weird.

has he ever explained why he keeps coming in for the tests? does he claim they were ordered by a refering doctor? are you able to call the doctors who order these tests and let them know what's going on? I know that in alberta no tests can be ordered without a doctor to order them and the results are always sent back to that doctor, who is supposed to tell the patient. But if this guy is going from doctor to doctor does he ever actually get any of the results?

is it possible that maybe once, years back his results got mixed up with someone elses and he was told he had HIV and Hep C and just never followed up or something?

Boo Radley · « **Reply #23 on:** December 21, 2006, 01:39:46 am »

Quote from: aupointillimite on December 20, 2006, 06:04:18 pm

More than likely, he's got Munchausen syndrome.

I have that. I've been taking HIV meds for the ultimate thrill they provide.

I didn't ever have Hep B either but the 3TC cured it anyway.

To be serious for a moment -- is HIPAA so meddlesome that you cannot be told this man's status from a doctor or lab department the next time he shows up? That's insane, but he sounds shy of a few bricks too.

Boo

RapidRod · « **Reply #24 on:** December 21, 2006, 05:23:03 am »

Coffee, when I worked the ER, Squad or Bird I was given some very special advice.

1. Be courteous.
2. Be professional
3. Most of all, don't fucking talk to them anymore than you have to. *

* If you talk and are nice, you'll see them every damn shift that you work. I believe anyone that has spent time working in the health care field can associate with that.

Coffeechick88 · « **Reply #25 on:** December 21, 2006, 06:52:46 am »

Quote from: AtomicA on December 21, 2006, 01:12:56 am

I don't know how this medical system bru-hah ha works, but is there even the slightest chance that he actually believes it? I mean he keeps coming in for these tests but who gives him the results? He'd have to be pretty freaking stupid to not think that the people drawing the blood and doing the testing would never figure it out... telling your friends and family you have HIV for the whole drama and sympathy of it is one thing but telling the medical community - the one group of people who can clearly call you on your bullshit - sounds really REALLY weird.

has he ever explained why he keeps coming in for the tests? does he claim they were ordered by a refering doctor? are you able to call the doctors who order these tests and let them know what's going on? I know that in alberta no tests can be ordered without a doctor to order them and the results are always sent back to that doctor, who is supposed to tell the patient. But if this guy is going from doctor to doctor does he ever actually get any of the results?

is it possible that maybe once, years back his results got mixed up with someone elses and he was told he had HIV and Hep C and just never followed up or something?

I thought of that possibility--that perhaps some incompetent person mislabeled a tube, but he should know by now. I know some doctors don't follow up on anything, but not all and to only go to doctors that don't follow up on anything, that seems like a statistical improbability.

Coffeechick88 · « **Reply #26 on:** December 21, 2006, 06:58:13 am »

Quote from: RapidRod on December 21, 2006, 05:23:03 am

Coffee, when I worked the ER, Squad or Bird I was given some very special advice.

1. Be courteous.
2. Be professional
3. Most of all, don't fucking talk to them anymore than you have to. *

* If you talk and are nice, you'll see them every damn shift that you work. I believe anyone that has spent time working in the health care field can associate with that.

I think that is good advice. It was easier to do that when I was an EMT (I did that then and went to college for clinical lab science and virology at the same time)--I worked in a really busy ER, always some sort of shooting going on, and I didn't have time to really talk to people much, but then I moved on to the lab--my first job we had absolutely no patient contact, and this is the first job I had where I actually had to deal with people more--a smaller place where they don't always have phlebotomists do do your draws for you and not as busy. So I guess you can say I am a relative newbie to all of this. I am very bad at staying around and talking when the patients start (especially the old people who probably never have anyone to talk to). I think that is at the root of my problems.

Basquo · « **Reply #27 on:** December 21, 2006, 08:39:26 am »

Coffeechick, sorry for the blank there, having network problems. You keep mentioning HIPAA; I just want you to know thatas long as you don't discuss his lab results casually, you're okay. I'm the Compliance Officer for my hospital so I deal with stuff like this every day. If you are involved with his treatment, and doing your job, there's no reason why you shouldn't know his tests results. He can't get you HIPAA-wise for knowing something that's part of your job.

The more pertinent issue is whether or not it's the scope of your job to have the discussion he needs or to give him a referral to another facility or a psych doctor, etc. If it's not, then tell your supervisor you'd prefer not to be involved with this patient's care. Say that he creeps you out.

And thanks for spelling HIPAA correctly!

Best,
Basquo

Iggy · « **Reply #28 on:** December 21, 2006, 08:52:39 am »

Coffeechick88 · « **Reply #29 on:** December 21, 2006, 10:33:22 am »

Quote from: Basquo on December 21, 2006, 08:39:26 am

Coffeechick, sorry for the blank there, having network problems. You keep mentioning HIPAA; I just want you to know thatas long as you don't discuss his lab results casually, you're okay. I'm the Compliance Officer for my hospital so I deal with stuff like this every day. If you are involved with his treatment, and doing your job, there's no reason why you shouldn't know his tests results. He can't get you HIPAA-wise for knowing something that's part of your job.

The more pertinent issue is whether or not it's the scope of your job to have the discussion he needs or to give him a referral to another facility or a psych doctor, etc. If it's not, then tell your supervisor you'd prefer not to be involved with this patient's care. Say that he creeps you out.

And thanks for spelling HIPAA correctly!

Best,
Basquo

On our first day of compliance training--she gave us a quiz as to how you spell HIPAA. This woman really does everything she can to put the fear of God into us--I guess that is a good thing from the hospital's stand point. Ironically, she is a rather gossipy woman and is someone in charge of privacy things, but that is another story. So by what you said, I don't think I can do anything more than just saying, "I'm busy" when he comes by or asking someone else to take over. Basically, my job--I do run the tests, sometimes it is when it is only me in the lab or I'll do it to be nice if there ends up being a backup. I do often talk with doctors about results, what they mean, what the best tests to run instead of what they ordered, that kind of thing. But since you said the scope of my job, that would probably mean I can't really do much. Would that mean I can tip off one doctor about a previous visit? It is really hard for the Doctors to know for various reasons--especially the ER doctors who don't really have anything to go on. So I guess if I were allowed to tell the doctor what he had done a previous ER visit, I'd have to let him/her decide what to do. But it seems to me, these doctors just want to make him someone else's problem.

GSOgymrat · « **Reply #30 on:** December 21, 2006, 10:52:32 am »

This problem isn't that unusual. We have a guy who comes into the psychiatric hospital regularly who insists he has tuberculosis, even though he has been told repeatedly he doesn't.

Andy Velez · « **Reply #31 on:** December 21, 2006, 11:00:25 am »

You've been thoughtful and understanding about dealing with this guy. But you don't have to take on the burden by yourself. There's some kind of pathology going on with this fellow. Until you know better what's going on I wouldn't disturb that by being confrontational in any way.

I suggest that you speak to whoever is on staff whom you think is appropriate. You don't even (initially) have to identify the person by name. Discuss what the general situation is and ask for advice/recommendation.

Keep us posted on how this goes.

Cheers,

bear60 · « **Reply #32 on:** December 21, 2006, 11:16:47 am »

I agree with Andy and Basquo. And I add: If this person is harmless ( he is not hurting himself or others) I think you should stay out of it and save yourself the stress. Absolutely: talk to a doctor or supervisor but I mean "why bother" comes to mind.

Coffeechick88 · « **Reply #33 on:** December 21, 2006, 01:58:35 pm »

I would do better in my life if I didn't let people drag me into their shit. Yes, normal people would be 'why bother with this wacko' but I tend to go overboard for people. :(I think part of it is that he is wasting everyone's time and resources of the hospital for his little fake illnesses, that part is annoying, plus it's just a little creepy and weird. I do realize that by talking to him and being too nice rather than doing only what I had to, I really brought this on myself and led to him being attached to me. I will just have to stick to my guns and have other people serve him when he asks for me and only be professional.

Ihavehope · « **Reply #34 on:** December 21, 2006, 02:09:44 pm »

Hey CoffeeChick

When i was diagnosed with having the HIV virus, my life changed in a dramatic way. It is a serious illness and for someone to pretend to have it and make a mockery of it, consciencely or unconsciencely makes me wanna smack this son of a b......

Someone who told me that I now need to think about ME more than ever. Those we love and care about come second and the world comes third. Therefore IGNORE him. Don't even look at him if possible because he is full of bad energy and we need less of it in our lives.

Happy Holidays.

gerry · « **Reply #35 on:** December 21, 2006, 10:29:47 pm »

Quote from: Coffeechick88 on December 21, 2006, 10:33:22 am

Would that mean I can tip off one doctor about a previous visit? It is really hard for the Doctors to know for various reasons--especially the ER doctors who don't really have anything to go on. So I guess if I were allowed to tell the doctor what he had done a previous ER visit, I'd have to let him/her decide what to do. But it seems to me, these doctors just want to make him someone else's problem.

You should check with your HIPAA compliance officer. I wouldn't think this would be any different from, for instance, the pharmacist tipping off a prescribing doc about a patient that is trying to fill several narcotic medication prescriptions from different docs over a relatively short period of time. Having said that, HIV test disclosures are more sensitive because, like mental health, drug abuse, and STDs, they're part of the so-called "superconfidentials." So you need to be very careful with what you do with this knowledge. Also, even if this is allowed, do you want to be the one to break this to the ordering doc? You might find yourself in a situation where this guy might want to retaliate against you if he found out you blew the whistle on him.

Quote

I will just have to stick to my guns and have other people serve him when he asks for me and only be professional.

I think that's the safest thing for you to do. If all else fails, "miss" 2 or 3 pokes the next couple of times and apologize to him and say you're not having a good day and get someone else to draw him

aupointillimite · « **Reply #36 on:** December 21, 2006, 10:38:53 pm »

Quote from: gerry on December 21, 2006, 10:29:47 pm

You might find yourself in a situation where this guy might want to retaliate against you if he found out you blew the whistle on him.

I'm afraid I'm really unknowledgable as to HIPAA laws... but I've read a bit of unofficial medical literature written by docs who confront Munchausens (and I still think that's what this guy is) about what they're doing.

It seems that a lot of them flare up ("how dare you disbelieve me?"), get really mad, and then go on to another doc to begin the cycle anew. They're not the type to go for lawsuits... the role of being a patient is comforting to them, and I'm (in my lay status) unaware of any legitimate trials against medical professionals brought by Munchausens.

But I would think it's the responsibility of whatever office, clinic, or hospital he's using to flat out tell the patient, "You are negative for the diseases you keep coming in for. We know what you're doing; here's the number to a therapist."

And coffeechick, you're really just feeding what he needs by engaging him vis-a-vis his fake illness. People like this require attention from medical professionals for their sense of well-being; giving it to him only reinforces his behavior. It's a for-real psychological problem... in the DSM-IV and everything.

Of course, that doesn't make it any less annoying or ridiculous...

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Author Topic: How do deal with someone you know is faking being HIV +? (Read 10310 times)