FROM time to time physicians are confronted with the problem of dealing with patients who have apparently wilfully fabricated symptoms and signs in order to secure medical attention. At times the story and alleged physical signs are so clumsily manufactured that the real situation is readily apparent. At other times they are so skilfully woven that much ingenuity is required in order to recognize the true nature of the malady and, sometimes, unfortunately, it is not recognized until one or more needless operative procedures have been carried out.
The motivating forces have varied as widely as the symptomatology. Sometimes the complaints have obviously been made in order to collect compensation, to secure narcotics, to avoid work or other duties, to escape unpleasant situations or for some other recognizable motive. At other times the motives are obscure. There is indeed a thin borderline between the patient who deliberately feigns illness but