Patient-Centered Medicine and Prevention of Munchausen Syndrome by Proxy

Munchausen syndrome by proxy (MSbP) is known by many names and is considered the deadliest form of child abuse. Although the condition was named in 1976 and there is now a substantial body of scientific literature about this type of abuse, to date, patient-centered approaches to early identification, intervention, and prevention have been absent from this literature. The purpose of this chapter is to recommend patient-centered approaches to identifying MSbP in the clinical setting to facilitate prevention and early intervention. It also recommends patient-centered practices that can be implemented to reduce the MSbP-related morbidity and mortality contributed by the healthcare system. The evolving nomenclature and definition of MSbP abuse has been an obstacle to achieving scientific consensus on the topic. Yet, the body of scientific literature on the subject is large. This literature is reviewed to enumerate the healthcare system's contribution to MSbP abuse. The Haddon matrix, a public health framework, is applied to MSbP abuse in order to guide the development of recommendations of patient-centered approaches that should be implemented to reduce the healthcare system's contribution to the morbidity and mortality that MSbP victims face.