Clinical Suspicion

The outright manufacture of symptoms by a nonpsychotic patient is a rare but serious and potentially life threatening pattern of behavior, and the most dramatic violation of the

^Editor's Note: This means not doing another endoscopic retrograde cholangiography or another colonoscopy just to "reassure" the patients.

doctor-patient relationship. One of its most difficult features is that it places the physician in the role of detective as much as doctor, a very uncomfortable turn of events for most caretakers. Moreover, factitious disorder may coexist with other significant medical illnesses, and, in fact, may make them more difficult to detect and diagnose. Nonetheless, a number of features may serve as warning indicators when patients are referred for consultation (Eisendrath, 1996). A history of complaints in times of personal stress may be difficult to elicit. However, when multiple physicians have been baffled or suspicious, or when the patient has felt disappointed, abandoned or betrayed by several doctors, concern is appropriate. Symptoms that fail to respond to appropriate treatments, or that worsen when they should have improved—especially when the patient knew they would worsen— should also arouse concern. A history of "bad luck" from an early age, or of repeated treatment complications should also serve as a warning. The disproportionate representation of health care workers among factitious disorder patients is also a clue in many cases.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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