Psychiatrists providing emergency services at an urban general hospital completed questionnaires on 227 patients evaluated over a two-month period to assess whether they suspected the patient of malingering or of having secondary gains, and whether the patient was confronted about the suspicions. Thirteen percent of patients were strongly or definitely suspected of feigning symptoms; none received a primary diagnosis of malingering, and less than half were confronted. Suspected secondary gains included food and shelter, medications, financial gains, and avoidance of jail, work, or family responsibilities.