221 Baker Street

It has been my project over the last few months to use my powers of observation to help weed out fakers at disability. If you recall from my first blog, approximately 20% of the patients I see are trying to get free money, even if that means faking symptoms, buying wheel chairs or bringing in pill bottles with someone else's name and hoping I don't catch it. One such gentleman presented this morning. He limped into the office, a quad-cane helping his balance, and told me that he had suffered a "very severe stroke" earlier this year that rendered the left side of his body useless. As he told me this, he emphasized his words by waving both arms, gesturing with both hands, and crossing his left leg over his right. He proceeded to tell me that he had been discharged from the hospital after "seven days because I had no insurance," and that he had relearned how to walk, talk and eat on his own. He stated that he used the cane for balance, because "without it, I can't really walk at all...and if I walk more than a block without it, I get really tired." In addition, he stated that he couldn't use his left hand to open doors, jars, whatever, and that his girlfriend helped him bathe and dress himself every day. So, as you might imagine, my suspicion that this guy was a faker began as soon as he started waving his arms all around. Now, people can make amazing recoveries from strokes, but usually there is quite a bit of rehab therapy behind that recovery, and according to this guy, he had been able to do everything by himself. To make things even fishier, he was not on any typical post-stroke medication; his entire med list consisted of aspirin, folic acid, and Lortabs (of course). The physical exam was even more non-convincing, as he proceeded to basically crush my fingers with his grip strength, and he was able to walk on his toes across the room, despite his previous statement that he couldn't lift his left leg.

Since I was already about 1,488,659% sure that this guy was faking, I decided to see if there were any other things that seemed out of the ordinary. First of all, his cane was almost brand new, without a scratch on it, not what you'd expect from someone who used it daily for support. Secondly, the nails on his right hand were clipped in way that the lateral portion of the nail was longer, just as if he had done the clippings himself. Thirdly, while the top of left boots was obviously dirty, the sole of the boot showed no signs of scuffing, which would be present on a shoe that was dragged along. I know, there are a number of things that could explain these "abnormalities." Maybe the cane (or boot) was new, and maybe his girlfriend never learned how to use a nail trimmer. I don't know. What I do know, however, was that these observations, coupled with his already dubious history and physical, lead me to believe that this dude was just in it for the free money. To cement my opinion, after the interview concluded, he proceeded to walk into the waiting room without his cane, and without any apparent balance issues. He stopped at the office door, turned around, walked back into the exam room and said, "huh, I guess I need that."

Being a good observer, much like being a good listener, is a skill that seems to be vanishing in our world today. Our daily lives are filled with so much junk that it makes it difficult to try and take everything in and really process the world around us. All of us have had experiences in the past that could've been avoided if we had just taken the time to really observe our surroundings. Think about the number of car wrecks that could be prevented if we just paid attention to the road, and weren't trying to change the radio station, put on makeup, eat or text while driving.

And now, for the disability quote of the day:

Patient's written reason for not working, and I quote:
"Disgrtv disc in lwr bck and diab"
(Apparently he lost control of his vowels)

Keep your eyes open,

-DD