Factitious disorder in healthcare workers

If factitious disorder is diagnosed in a health-care worker, the investigating psychiatrist should consider whether their continuing clinical work would pose risks to either patients (often children) with whom that person comes into contact (i.e. of factitious disorder by proxy), and/or the health of the factitious disorder patient him- or herself. These issues have been thrown into sharp focus by some highly publicized cases in both the United States and the United Kingdom. (26,27) Any employee who manufactures crises, for example multiple cardiac arrests and resuscitations, is obviously of great concern. The British commision that investigated the 1993 case made several stringent recommendations, for example 'We recommend that no candidate for nursing in whom there is evidence of major personality disorder should be employed in the profession'/28 Nevertheless, psychiatrists should seek medico-legal advice before communicating concerns about such patients to any third party, including the employing hospital.

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