Factitious disorders: potential litigation risks for plastic surgeons.

Patients with factitious physical disorders can present with a myriad of signs and symptoms. Common presentations include persistent wounds and abscesses that are often treated by plastic surgeons. Because these individuals are surreptitiously trying to maintain their illness, rather than recover, adverse outcomes are common, particularly when the plastic surgeon has not detected the factitious etiology. Well-meaning plastic surgeons trying to help difficult-to-treat patients may be at high risk for poor outcomes with factitious disorder patients. When these outcomes occur, these patients may focus their underlying anger or other feelings on their plastic surgeons and may initiate litigation. This article discusses 2 cases in which plastic surgeons were sued for malpractice by factitious disorder patients. We outline clues to the recognition of factitious disorders and steps the plastic surgeon can take to initiate appropriate treatment, which may reduce the risk of litigation.