Hospital hoppers--jumping to conclusion?

In 1951 Asher applied the term 'Munchausen's syndrome' to a group of patients admitted with an apparent acute illness supported by a plausible and dramatic history which was found subsequently to be made up largely of falsehoods. The patients were found to have attended and deceived an astounding number of hospitals and discharged themselves against advice, often after quarrelling with nursing and medical staff. One illustrative case history documented 18 different hospital admissions. Asher commented at the time that 'the patients gained nothing but the discomfort of the investigations and often operations. The patients appeared to have an intense desire to deceive everybody as much as possible'. However Asher did suggest in the same article that the patient's motive for the deception may be a desire to be the centre of interest and attention (Walter Mitty syndrome) if not being the surgeon they could still gain from the equally dramatic role of being the patient! Munchausen's syndrome is used synonymously with chronic factitious illness (American Psychiatric Association, 1987). It is suggested (Pankratz, 1981; Ford, 1986) that besides factitious illness the patient should fulfil the two other main characteristics in Asher's description peregrination and pseudologica fantastica to be diagnosed as Munchausen's syndrome. The very name has been criticized (Patterson, 1985) and others have been suggested: 'Hospital Hoboes', 'Hospital Vagrants', 'the desire to be ill' (Parker & Barrett, 1991). In the West Midlands these patients are termed 'Hospital Hoppers'. The syndrome has been extended to take in a particular form of child abuse Munchausen's syndrome by proxy (Meadow, 1977). Patients continue to deceive and doctors continue to write about it. It has been suggested (Markantonakis & Lee, 1988) that a central register of known sufferers be established by the Royal College of Psychiatrists. Many of these patients present to accident and emergency (A&E) departments in an attempt to gain admission to hospital. Many are identified by experienced staff, often it seems, without reference to any file. Within the West Midlands Health Authority an informal system of notification of other hospitals has become established. A&E departments receive occasional letters giving some patient details and history relating to previous attendance(s) but there is not, it would seem, an organized system of identification or notification of these cases.