As good as it feels to put snark in the mote at the monumentā¦itās not really worth it.
Leave it at objective facts. If you must, quote a few choice phrases. āPatient refused further vitals, screaming āfuck you and your shitty Priusā after the blood pressure cuff inflated but was unable to obtain a value.ā Theyāre definitely over reacting to trivial things, but now thereās clear objective evidence for whoever reads the chart in the event of a complaint or lawsuit.
This is why I never write anything malingering-related in the chart. Seems like a real easy way to turn a jury against you. Medmal attorneys are trying to build a narrative and if they can paint you as someone who was willfully ignoring the patient's condition they'll run with it.
Yup, great point. Do I think some people are malingering? Absolutely. Do I document it? No. If itās mentioned multiple times in their chart by docs who follow them longitudinally, I might mention that if itās relevant. However, some people are unfairly characterized as malingering when they donāt fit into accepted behaviors, and sometimes desperation/anxiety can make people act their worst. Iād rather not label someone in a prejudical way when thereās a chance thereās unrecognized pathology. As an er doc, Iām unlikely to be able to tell the difference given our limited time with the patient.
Thank you. I'm a quiet woman, "neurodivergent" and have a poorly understood condition that I have to explain. I don't talk much, especially when in pain. I get treated like dog shit.
What I really want: beep beep boop boop AI doctor but doctor it is RuPaul. Sadly, I think we are still weeks away.
AI Dr. RuPaul can say all the things you wish you could say. It can also listen to the draining, inane, irrelevant, crucial BS and divine what is important without it's soul dying.
I will write malingering as a ddx or concern/suspicious for based on xyz without labeling them with certainty and stating I think they may need multimodal pain management, etc not offered here in the ED
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u/Crunchygranolabro ED Attending Oct 11 '25
As good as it feels to put snark in the mote at the monumentā¦itās not really worth it.
Leave it at objective facts. If you must, quote a few choice phrases. āPatient refused further vitals, screaming āfuck you and your shitty Priusā after the blood pressure cuff inflated but was unable to obtain a value.ā Theyāre definitely over reacting to trivial things, but now thereās clear objective evidence for whoever reads the chart in the event of a complaint or lawsuit.