Case Vignette

Overreaction And Inconsistency

Not all patients are ridgy-didge. Not all patients are as badly affected as they have you believe. Not all presentations can be explained in purely orthopaedic terms.

patient holding back for pain3

That is to say, some patients overreact, behave inconsistently, embellish their circumstance or may even be true malingerers.

Differentiating between real and contrived presentations can be difficult and requires experience. Expressing opinions on the matter requires care and sensitivity.

patient moaning

There are no precise tests which can accurately and routinely differentiate between the real and the apparent. Orthopaedic surgeons do have some tests that they can perform which may indicate inconsistency and/or overreaction should those variations exist.

Interpretation of the tests should be carried out judiciously. If they are positive, they should be explained in detail in the report.

A courteous way of referring to the differential may be in the phrase “The presentation does not conform with any orthopaedic condition with which I am familiar”.

Patient holding dollar bills2

Useful tests include the application of different forces, at different times, in different locations during an examination. Sometimes a plaintiff may perform identical functions in different situations differently. Huffing, puffing, moaning and groaning are also noteworthy.

Not every case is as it might seem.