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
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.
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"
Graphic: Photo Credit: memekode on Flickr