Bioethics Discussion Blog: MUNCHAUSEN SYNDROME BY PROXY: The Potential for Medical Profession to be Co-Participants in Child Abuse.

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Wednesday, December 25, 2013

MUNCHAUSEN SYNDROME BY PROXY: The Potential for Medical Profession to be Co-Participants in Child Abuse.










A father brings his young son to the doctor for prescription medications because the father suspects that the son has "classic" attention deficit/hyperactivity disorder.

The  mother relates to the hospital emergency room with  a history of multiple respiratory, gastro-intestinal and musculo-skeletal symptoms from which her child was suffering and insists that  the child be "hospitalized" for a "complete workup".  A basic workup in the emergency room discloses no disease, the child was not admitted but the mother was told to have followup with a pediatrician.  She returns to the emergency room two days later with the child and more symptoms, requesting the child's admission but having not attempted to visit a pediatrician.

A mother brings a child to the pediatrician because the child has been losing weight.  According to the mother,  multiple food allergies was suspected by the family and the child's diet was markedly reduced (starving) in order to prevent symptoms.

The mother brings a child to a pediatrician pointing at the multiple bruising over the child's body  and giving a history that the child was having recent repeated nosebleeds.  The  physician's examination finds the nasal passages to be normal and the bruises have more the appearance that they were due to trauma and not spontaneous.

What you have read are various degrees of clinical appearances of a condition known as "Munchausen Syndrome by Proxy"(MSP).  The definition of the Munchausen Syndrome itself without "proxy" is a patient's specific mental or behavioral disorder in which the individual fakes a medical illness in order to get medical attention.  In "Munchausen Syndrome by Proxy", this behavior represents medical attention directed to another (usually a child)  because of a fictional history or frank physical or mental abuse by another person usually the caregiver or parent.  Other names given to this state include "factitious disorder by proxy" or the current 2013 American Psychiatric Association title  "factitious disorder imposed by another".  Regardless of the title of this state,  it defines the unnecessary introduction of a child by a caregiver into the medical system for diagnosis and for the treating a "made up" disorder. This factitious disorder imposed by the caregiver can be related to simply the caregiver's  medical ignorance and may be to some extent unintentional, however it also can be motivated by some sort of personal gratification and may include  frank intentional physical or mental abuse of the child to create an appearance of the disorder.

 One might conclude that as a result of the inherent risks of unnecessary diagnosis and treatment the medical profession could be said to be "co-participants" in the child abuse if the healthcare providers at the outset fail to attempt to identify the syndrome  as being present.

It therefore become a duty of the initial physician consulted  to always be aware of the possibility that their child patient may be a victim of a factitious disorder imposed by another.  If that possibility is suspected,  an active attempt to confirm is essential before subjecting the child to hazards of unnecessary diagnosis and treatments.  This means taking a detailed patient history from the parent but also including the parent's medical understanding of the symptoms presented, performing a careful physical examination, communicating with the patient's prior physicians and other pertinent resources including pediatricians who specialize in MSP  as needed for assistance in confirmation. And, if Munchhausen Syndrome by Proxy is confirmed, it should be seriously evaluated as child abuse and consideration for appropriate civil/legal action to be taken for the protection of the child.  Missing to consider and investigate this diagnosis,  the physician and the medical system could be looked upon as co-participants in any damage to the child. 

For more on this topic, read the statement about this issue by the American Academy of Pediatrics and the description in Wikipedia.


After reading about this subject, can you defend the accusation that the physicians involved could be considered as co-participants in child abuse?  And another question: as personal matter, if you brought your child to a pediatrician, how would you feel if you knew the doctor was surveying you as a "by proxy" candidate? ..Maurice.

Graphic: Photo Credit: memekode on Flickr

1 Comments:

At Thursday, January 02, 2014 10:44:00 AM, Anonymous Anonymous said...

Is it really a good idea to teach medical students about Munchausen Syndrome, Munchausen Syndrome by Proxy, and Somatization disorder - things that lead doctors to dismiss patients symptoms and tell them their symptoms are in their heads? After all, didn't you say elsewhere you felt it was counter productive to teach students about normal traumatic reactions because it might hinder the students performance during an examination to be aware of it?

Acording to AARDA:
Almost half of those who are diagnosed with autoimmune diseases are told they are "overly concerned with their health" prior to diagnosis.

There are more people with autoimmune disease than with heart disease. (NIH statistic)
http://www.aarda.org/autoimmune-information/autoimmune-statistics/

I don't believe Somatization disorder exists. I believe that people have illnesses we can't diagnose - but that doesn't mean they aren't sick.

I do agree that learning coping strategies to deal with sickness can improve outcomes, and that poor coping strategies can lead to added distress. Part of that distress is dealing with people who don't believe they are sick. Expanding counseling options for those who are chronically ill (with our without a diagnosis) is an important health strategy due to this. But there is a big difference between "get counselling because nothing is really wrong with you" and "we can't find what's wrong with you, so we want you to work with a counselor to learn coping strategies which will help reduce your symptoms while we monitor your condition."

Bad doctors dismiss their patients when they can't figure out what's wrong. Good doctors monitor the progression of the disease so a diagnosis can be made at a later date.

Women are generally the ones most likely to complain about "illnesses that don't exist." Women are 3 - 4 times more likely to develop an autoimmune disorder then men. I think the connection is rather obvious - these women are really sick.

Important Reading (also reference for 3/4 times likely):
http://www.aarda.org/autoimmune-information/autoimmune-disease-in-women/

-JR

 

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