This question was originally posted on Quora.com and was answered by Carmel Maalouf, former Clinical Reviewer in Risk Management Cardiac Cath. First of all, practitioners know that everybody lies. If a person says that they are vomiting repeatedly and can’t keep anything down they should have inflammation in their throat and signs of dehydration which may also show up in a basic chem blood test. If diarrhea is the issue stool samples and blood work for inflammatory markers will help tell if the person is ingesting cathartics to achieve weight loss or has an autoimmune or infectious condition. If a person is faking neurologic issues, an ortho or neuro person can do some maneuvers which will clue them in, but a nerve conduction study and review of reflexes will also be telling. An MRI is a very expensive test that insurances may delay paying for for 3 months in some circumstances like back pain because most people get better within that time. Toxicology testing may be another clue to Munchausen syndrome or faking to receive some type of benefit like drugs or a workers comp claim, or attention. If a person will only be compliant with narcotic therapy and will not attend referrals for PT, Chiropractic, and change lifestyle issues which contribute to their expressed condition those are red flags. The internet has improved patient access to signs and symptoms of illness, but it doesn’t replace experience and education in the long run. If a person causes themselves harm or is evasive or in other ways not forthcoming with the truth they still have illness which should be evaluated by a mental health professional. Source
