Managing surgical patients with serious mental illness: can we do better?

Facing the faceless patients - the emerging challenges of identity fraud in general surgery: A case series

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Identity fraud is becoming a more recognizable challenge, particularly with the introduction of electronic medical records.

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Particularly in surgery, identity fraud can result in significant harm to patients and burden to the health care system.

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Clinical vigilance and implementation of strategies to reduce system error can reduce the negative impact of identity fraud.

Introduction

This case series highlights the challenges faced in general surgery when encountering patients who use multiple false identities and provide unreliable histories.

Presentation of cases

We present two patients both with a background of mental health disorders and previous abdominal surgeries. After extensive workup with one patient almost proceeding to surgery, it was noted that these patients have had multiple presentations under different aliases to multiple different hospitals and had given inconsistent medical and surgical histories.

Discussion

In such patients, history and clinical examinations are unreliable. Medical records are also not helpful given the patients’ multiple aliases. Particularly in surgery, inaccurate knowledge of the patients’ previous operative details can lead to significant harms. Extensive investigations are usually performed in assessing these patients, resulting in excessive radiation exposure and incurring significant costs to the health system. It is also important to recognise the potential legal repercussions and harms to the patients who have had their identities stolen.

Conclusion

Identity fraud poses significant challenges to patient care, vigilance from clinicians and implementing strategies to reduce system error can help to limit harms to the patient and the health care system.