Munchausen by proxy (MBP) is a condition first described in human medicine 30 years ago, in which parents or guardians feign or create illness in their children to receive and maintain the attention of physicians and medical staff. Most people with MBP fall into 1 of 3 categories: 1) doctor addicts, who believe the child is sick, but report false symptoms to increase attention; 2) help seekers, who generate or falsify symptoms and are grateful when these symptoms are alleviated; and 3) active inducers, who will cause symptoms and undermine the doctor's attempts to resolve them. In veterinary medicine, most clients with MBP are women with some medical background who are well liked by the veterinary staff because of their seeming dedication and willingness to help. In addition to the effect this can have on the patient, MBP can be devastating for the veterinarian and staff, who feel betrayed when their trust in the client is broken. There are problems with the definition and diagnosis of this condition in veterinary clients. Veterinarians are not likely to have the wherewithal to use hidden camera monitoring of the patient, as is done in human medicine. In addition, legal implications and the potential negative effects on a practitioner's reputation if a client were accused of MBP need to be considered. Thus, legal advice should be sought before confronting a client. Prevention, in the form of maintaining balance in all client interactions and relationships, is recommended. This would entail generating an aura of general caring for patients and clients but at the same time creating just enough space between the practitioner and the patient and client to maintain integrity and objectivity.

COMMENTARY: Veterinarians generally enter the profession out of a deep compassion for animals and a desire to "do good." This article addresses a concern for veterinarians whose compassion can sometimes leave them open to trouble: Munchausen by proxy. Most likely, it would be rare to encounter a client with this disorder and nearly impossible to confirm it if it were suspected. It does, however, emphasize the need to maintain a certain degree of professional distance and objectivity in client interactions. It is not that uncommon to have clients who will take advantage of a veterinarian's well-meant compassion. We can still be compassionate, competent doctors without having to be personally on-call 24/7 for owners of chronically ill patients.

Problematic client-animal relationships: Munchausen by proxy. Milani M. CAN VET J 47:1161-1164, 2006.