Patient faking seizure in the ER and how to handle.

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By Joel A. Stettner, MD

If you've worked the emergency room for any length of time, you've likely heard some pretty creative stories from people trying to illegally obtain a controlled substance.

This rather humorous video of a patient faking a seizure in the emergency room is making the rounds on YouTube and has created quite a buzz on the internet. While it's meant to be funny - and certainly exaggerates - a lot of the dialog hits pretty close to home.

My community hospital has its share of folks who seem to be seeking drugs; they can be pretty creative, both in terms of how they present and how they identify themselves. After a lot of thought and discussion, we created a "Treatment Plan" approach to help deal with these individuals.

Once they have been identified, and their medical history reviewed, each is sent a registered letter clearly identifying our assessment of the problem and our plan to deal with it during future visits. Where possible, any outside PMD and/or clinic used by the patient is involved in plan development, and incorporated into the specific steps we will follow. The letters, which outline each specific plan, are maintained in a binder for easy ED MD access; we are trying to add a flag to our ADT system as well (not so easy).  There are now well over one hundred such letters.

Having the physician reference the letter and Treatment Plan during the patient's visit has been very helpful in controlling this problem. We of course do not deny an MSE, nor do we absolutely refuse narcotics, etc. in the face of obvious need. But over time, the number of inappropriate visits and demands has dropped off.

This arrangement works for us, but I would be interested to know what types of procedures you use in your emergency department to combat this problem.