19 February 2008
A fatal case of secondary gain; a cautionary tale
Michael D. Freeman, Christopher CentenoAm J Case Rep 2008; 9:97-103 :: ID: 828544
Abstract
Background: The term “secondary gain” is rarely heard outside of a medicolegal context, and is a disparaging term used to describe a patient with a compensable injury in whom symptom exaggeration or fabrication is suspected. The allegation of secondary gain is difficult to confirm, and may arise from a lack of an appropriate diagnostic evaluation and proper attribution of symptoms to pathology. Additionally, clinicians who allege secondary gain or malingering in a patient in the absence of clear evidence may be motivated by economic incentives to make such determinations.
Case Report: We present a tragic case study in which a 32-year-old man with obvious signs of acute posttraumatic cervical myelopathy was subjected to multiple evaluations by more than 10 various clinicians over an 8 month period before he was referred for a cervical spine MRI. Although the patient underwent surgery to decompress the lesion, ultimately he died from an overdose of narcotic pain medication associated with a residual central cord pain syndrome.
Conclusions: There were a variety of systematic or “secondary gain” pressures acting on the clinicians in this case that may have led to the lack of a definitive diagnosis and the resulting improper care. This included a business model that emphasized repeated treatment in the case of the treating chiropractors and the desire for future employment in the case of the physician performing the insurer-mandated evaluation. It is reasonable to examine the motivation of clinicians who allege secondary gain in a patient in a third party evaluation setting.
Keywords: secondary gain, Malingering, cervical myelopathy
In Press
12 Mar 2024 : Case report
Successful Treatment of Lithium-Induced Nephrogenic Diabetes Insipidus with Celecoxib: A Promising Therapeu...Am J Case Rep In Press; DOI: 10.12659/AJCR.943244
13 Mar 2024 : Case report
Recurrent Marginal Zone Lymphoma with Bone Marrow Involvement Detected by ¹⁸F-FDG PET/CT and Biopsy: A Diag...Am J Case Rep In Press; DOI: 10.12659/AJCR.943275
13 Mar 2024 : Case report
Unveiling the Temporal Aspect of MRI Tattoo Reactions: A Prospective Evaluation of a Newly-Acquired Tattoo ...Am J Case Rep In Press; DOI: 10.12659/AJCR.943411
13 Mar 2024 : Case report
Cardiac and Intramuscular Metastases Following Nephroureterectomy for Metachronous Urothelial CarcinomaAm J Case Rep In Press; DOI: 10.12659/AJCR.942864
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250