Some questions I'm stuck with: * are all the patients really sick or as sick as the symptoms he documents, or is it some kind of Munchausen induced or lied abo

Some questions I'm stuck with: * are all the patients really sick or as sick as the symptoms he documents, or is it some kind of Munchausen induced or lied about by the doctor? * Or are they all sick, they're just not getting the help they need because he wants to have a mystery disease? * If they're all sick, is it then a higher prevalence than expected, so even if there is no mystery disease there is still something environmental or similar that should've been explored? Aka, is there a cluster, it's just a known disease?