Tuesday, September 23, 2008

"Ada-ada" Syndrome (2)

Ok now we've gone through the definition of it, maybe we can share some tips on diagnosing it. And bear in mind that this syndrome is most commonly seen on Saturday morning (coz can get a 2-day MC for good weekends off) and Sunday night (feeling lazy to go back to work after enjoyed weekends).

From what I observed, most common "excuses" are headache, abdominal pain with diarrhea, low back pain, URTI symptoms and some others.

The key point is, patients can fake the symptoms, but rarely the signs. (Of course, it's possible in "professional" malingering pt or in factitious disorder/Munchausen syndrome etc.)

For complaints of cough/fever/sorethroat, it's not difficult to differentiate the "self-made" cough from the chesty ones. And, look for temperature, chest signs, injected throat or enlarged cervical lymph nodes. If they are present, then "Ada-ada" syndrome is unlikely.

For AGE (acute gastroenteritis) symptoms, you should be able to spot whether the abdominal pain is really "colicky" in nature, if you have experienced before. Things hard to be faked including the hydrational status, the abdominal tenderness and also the hyperactive bowel sounds. Look at pt's facial expression when you examine abdomen. Pt with "Ada-ada" syndrome, will forget about their abdominal pain with little distraction like, talking to them while examining the abdomen.

Low back pain are way too common. Some "smart" ones will know how to fake the SLRT (straight leg raising test). But there's a way to counter it. If you see a patient is able to sit upright with both knees extended on bed, and without pain, you know the SLRT is definitely negative. It's just same as you've raised their legs to 90 degrees!
And remember to look for muscle spasm. Tenderness is easy to fake but muscle spasm is a real sign.

Hmm I hope the tips will be useful. But I think the most difficult one would be "headache", as this complaint is so subjective, with hardly any obvious signs. Anyone has any good idea?=)

Ohya one last important diagnostic sign. If you see a patient who told you he has got severe back pain/ abdominal cramp, after given MC, walked off happily like healthier than you, it's highly suggestive of "Ada-ada" syndrome too.

But that will be a bit too late la. =)


rainbow angeles said...

i'm the type who's shy to ask for MC eventhough i don't do the "ada-ada" syndrome... and the docs i go to, they always pretend to "forget" abt giving me MC wan.. :-(

Zzzyun said...

i think another symptom that they use is period pain.. that one is quite hard to determine whether it's true onot also right?

and here are more tips on how to know whether they are just after MCs.

1. they come on mondays too. and their symptoms happen to appear just right before they are in time to start work. or they put off seeing the dr till mondays.

2. if in a clinic, their treatment/consultation is most probably paid by their company. thats why they dont mind seeing the dr as they dun need to pay a penny.

3. if the dr doesnt think he needs a MC hence not mentioning it, the patient will be more anxious over the MC instead of his "disease" or the treatment he will be getting.

omg look at these tips.. im not yet a dr..but i seemed to have seen quite a few of these sort of patients! o.O

Darren Lee said...

rainbow: Ha so cute la you. If you're really sick and think you can't work, of course you can ask for a MC. No need to be shy!=)

zzzyun: Wow you analyzed it just like a pro..seems very experienced la you haha. Good la early exposure so you can handle it better next time..ha

Zzzyun said...

haha..but the thing is i might be able to identify these patients, but dont hv much idea on handling them..

i feel scared to reprimand them..

besides if u dont give them an MC, and something happens at work, wouldnt u be held responsible for it? oh noes!!

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