Worsening mental health in society

[genop]

Not really. I think you guys are making incorrect assumptions about people’s intentions. If someone asked me, “Don’t you think x, y, z? If I didn’t, I would say no. If I did, I would say yes. I wouldn’t feel trapped to agree, or have the onus on me to defend my position. However, it would give me information on what that person thinks, which can be useful.

“Don’t you think…” kills two birds with one stone. It gives the message that the person using it does think that and they are wanting to know if you agree. It’s a shorter version of saying, “I think x, y, z. Do you agree? Or What do you think?”

If someone asked me, “Don’t you think this painting is beautiful?” It would let me know that they do, but I wouldn’t be under any pressure to say yes. They are wanting my opinion, so if I didn’t think it was beautiful, I would just say it’s not my cup of tea. However, If they just asked, “Do you think this painting is beautiful?” It wouldn’t give me any information on what they think of it.

Not everyone has bad intentions when they say something differently than how you would choose to say it, or if they don’t think exactly the same way as you about different issues.

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[PsyDr]

Not really. I think you guys are making incorrect assumptions about people’s intentions. If someone asked me, “Don’t you think x, y, z? If I didn’t, I would say no. If I did, I would say yes. I wouldn’t feel trapped to agree, or have the onus on me to defend my position. However, it would give me information on what that person thinks, which can be useful.

“Don’t you think…” kills two birds with one stone. It gives the message that the person using it does think that and they are wanting to know if you agree. It’s a shorter version of saying, “I think x, y, z. Do you agree? Or What do you think?”

If someone asked me, “Don’t you think this painting is beautiful?” It would let me know that they do, but I wouldn’t be under any pressure to say yes. They are wanting my opinion, so if I didn’t think it was beautiful, I would just say it’s not my cup of tea. However, If they just asked, “Do you think this painting is beautiful?” It wouldn’t give me any information on what they think of it.

Not everyone has bad intentions when they say something differently than how you would choose to say it, or if they don’t think exactly the same way as you about different issues.

What kind of healthcare professional are you?

You're using a structure, and evidence base that is NOT seen in healthcare.

 

[deleted1038433]

What kind of healthcare professional are you?

You're using a structure, and evidence base that is NOT seen in healthcare.

Lol I thought the same thing that they come across as a mental healthcare professional parading as an ER doc. Sorry genop. Maybe you should be a therapist?

 

[cara susanna]

What kind of healthcare professional are you?

You're using a structure, and evidence base that is NOT seen in healthcare.

Lol, I keep thinking about how women's healthcare especially doesn't meet these standards.

 

[genop]

You're using a structure, and evidence base that is NOT seen in healthcare.

May I ask you to elaborate? I’m not sure I know what you mean.

 

[PsyDr]

May I ask you to elaborate? I’m not sure I know what you mean.

You’re repeatedly dodging my question. You are citing your own expertise for your opinions. What kind of healthcare professional are you?

Why are you not using professional terms? Why are you citing anecdotal evidence to the exclusion of any professional source? Why do your propositions have multiple items? It’s not how professionals write.

It’s like saying “chemicals cause cancer. My friend noticed that”. Any oncologist would notice you are not saying the specific type of neoplasm, or chemical, or route of exposure or any of that.

 

[genop]

You’re repeatedly dodging my question. You are citing your own expertise for your opinions. What kind of healthcare professional are you?

Why are you not using professional terms? Why are you citing anecdotal evidence to the exclusion of any professional source? Why do your propositions have multiple items? It’s not how professionals write.

It’s like saying “chemicals cause cancer. My friend noticed that”. Any oncologist would notice you are not saying the specific type of neoplasm, or chemical, or route of exposure or any of that.

I don’t feel comfortable sharing what kind of healthcare professional I am, but I have a doctorate. You don’t have to believe me.

I was using professional terms, but there’s not established pathophysiology behind most of these mental health diagnoses. Therefore, I can’t talk about it the same way one would talk about the pathophysiology of cancer.

In my original post, I made it clear that I was posting my thoughts and opinions, not primary literature or a journal club presentation.

 

[MCParent]

You don’t have to believe me.

Whew.

 

[PsyDr]

I don’t feel comfortable sharing what kind of healthcare professional I am, but I have a doctorate. You don’t have to believe me.

I was using professional terms, but there’s not established pathophysiology behind most of these mental health diagnoses. Therefore, I can’t talk about it the same way one would talk about the pathophysiology of cancer.

In my original post, I made it clear that I was posting my thoughts and opinions, not primary literature or a journal club presentation.

If that is your version of using professional terms, I don't believe you.

 

[genop]

Physical health disparities and mental illness: the scandal of premature mortality | The British Journal of Psychiatry | Cambridge Core

Physical health disparities and mental illness: the scandal of premature mortality - Volume 199 Issue 6

www.cambridge.org

This article isn’t from the US, but it’s still interesting, and there are similar issues here. Excerpt from the article:

People with mental illness are also less likely to receive effective screening for cancer and have higher case-fatality rates. This is partly due to the particular challenges when treating these patients including medical comorbidity, drug interactions, lack of capacity and difficulties in coping with the treatment as a result of psychiatric symptoms. Reference Howard, Barley, Davies, Rigg, Lempp and Rose7 But more generally there is now strong evidence that people with mental illness receive worse treatment for physical disorders (‘diagnostic overshadowing’). This takes place because general healthcare staff are poorly informed or mis-attribute physical symptoms to a mental disorder. For example, after adjusting for other risk factors, such as cardiovascular risk factors and socioeconomic status, depression in men was found to be associated with an increase in cardiovascular-related mortality. Reference Desai, Rosenheck, Druss and Perlin8

It seems clear, therefore, that medical staff, guided by negative stereotypes, tend to systematically treat the physical illnesses of people with mental illness less thoroughly and less effectively. For example, people with comorbid mental illness and diabetes who presented to an emergency department, were less likely to be admitted to hospital for diabetic complications than those with no mental illness. Reference Sullivan, Han, Moore and Kotrla9 It is clear that such consistent patterns of less access to effective physical healthcare can be considered as a form of structural discrimination. Reference Thornicroft, Brohan, Rose and Sartorius10

If such a disparity in mortality rates were to affect a large segment of the population with a less stigmatised characteristic, then we would witness an outcry against a socially unacceptable decimation of this group. The fact that life expectancy remains about 20 years less for men with mental illness, and 15 years less for women with mental illness denotes a cynical disregard for these lost lives, and shows, in stark terms, by just how much people with mental illness are categorically valued less than others in our society. This can justifiably be seen as a violation of the ‘right to health’ as set out in Article 12 ‘The right to the highest attainable standard of health’ of the International Covenant on Economic, Social and Cultural Rights. 11 Further, in 2006, the United Nations General Assembly adopted the Convention on the Rights of Persons with Disabilities that explicitly applies to people with mental health problems as well as people with intellectual disabilities. The Convention on the Rights of Persons with Disabilities defines the protections and entitlements of the 650 million people with disabilities worldwide. In relation to the current violations of these legitimate expectations to equivalent years of life, Wahlbeck et al are correct to conclude that their results imply a ‘failure of social policy and health promotion, illness prevention and care provision’.

Links to the primary literature is in the references of the article.

 

[AcronymAllergy]

My take: I would argue that because some healthcare providers exhibit bias toward individuals with a mental health disorder doesn't mean we should throw away mental health diagnoses. Rather, it means we need to educate the providers and address their biases. Some headway, I believe, is being made here by embedding psychologists in medical settings such as primary care, oncology, transplant teams, and general inpatient medical units. Interventions for pain management, diabetes, and smoking cessation that are being more readily/fluidly integrated into non-mental health clinics is another (related) example. For me, in neuropsych, I see it with referrals from PCPs and neurologists that essentially equate to, "please help me figure out if this patient has objective cognitive problems, if this stuff is due primarily to mental health difficulties, or both"; I've appreciated that they were realizing the interplay between these factors and were looking for recommendations in how to approach the case.

 

[Sanman]

My take: I would argue that because some healthcare providers exhibit bias toward individuals with a mental health disorder doesn't mean we should throw away mental health diagnoses. Rather, it means we need to educate the providers and address their biases. Some headway, I believe, is being made here by embedding psychologists in medical settings such as primary care, oncology, transplant teams, and general inpatient medical units. Interventions for pain management, diabetes, and smoking cessation that are being more readily/fluidly integrated into non-mental health clinics is another (related) example. For me, in neuropsych, I see it with referrals from PCPs and neurologists that essentially equate to, "please help me figure out if this patient has objective cognitive problems, if this stuff is due primarily to mental health difficulties, or both"; I've appreciated that they were realizing the interplay between these factors and were looking for recommendations in how to approach the case.

In addition to that, I think a larger issue is the collision between RVU driven medicine and the thought processes and speech patterns we often see in those with mental health diagnoses. From anxious folks who cannot easily focus to SMI folks that are even mildly disorganized, these people cannot communicate their needs in an efficient manner. Medical staff have less time and patience than in years prior and problems often go neglected due to these difficulties. Add in social welfare issues and you have a can of worms many folks do not want to deal with because the job is easy RVUs and paperwork. Not complicated uncompensated headaches that may improve quality of care for the least able among us.

 

[cara susanna]

Honestly, sometimes I think patients just need providers to listen to them and provide emotional support vs. putting in a consult for MH that's at least a few months out. PACT could do that if they had more time. Sometimes they put in consults for people who already in therapy, like they don't even have time to check that.

 

[chicandtoughness]

Not really. I think you guys are making incorrect assumptions about people’s intentions. If someone asked me, “Don’t you think x, y, z? If I didn’t, I would say no. If I did, I would say yes. I wouldn’t feel trapped to agree, or have the onus on me to defend my position. However, it would give me information on what that person thinks, which can be useful.

“Don’t you think…” kills two birds with one stone. It gives the message that the person using it does think that and they are wanting to know if you agree. It’s a shorter version of saying, “I think x, y, z. Do you agree? Or What do you think?”

If someone asked me, “Don’t you think this painting is beautiful?” It would let me know that they do, but I wouldn’t be under any pressure to say yes. They are wanting my opinion, so if I didn’t think it was beautiful, I would just say it’s not my cup of tea. However, If they just asked, “Do you think this painting is beautiful?” It wouldn’t give me any information on what they think of it.

Well, we at least know that you're not a mental health professional because your "don't you think" is that "leading question" thing they teach you not to do in month 1 of practicum

It seems clear, therefore, that medical staff, guided by negative stereotypes, tend to systematically treat the physical illnesses of people with mental illness less thoroughly and less effectively. For example, people with comorbid mental illness and diabetes who presented to an emergency department, were less likely to be admitted to hospital for diabetic complications than those with no mental illness.

OP do you work in the ER like you say you do? If that's the case you would know they call psych and neuro consults on everything lol. They clear the mental illness aspect first if someone is a danger to self and then work on the physical. I don't think it's one or the other. And no psych physician will admit someone to their unit if they have medical complications. I can agree with your posted article in outpatient settings, but if you really work ER you know the reality of this.

With a doctorate, you're either a PharmD, DPT, DNP, or you have a non-healthcare doctorate.

 

[genop]

Well, we at least know that you're not a mental health professional because your "don't you think" is that "leading question" thing they teach you not to do in month 1 of practicum


OP do you work in the ER like you say you do? If that's the case you would know they call psych and neuro consults on everything lol. They clear the mental illness aspect first if someone is a danger to self and then work on the physical. I don't think it's one or the other. And no psych physician will admit someone to their unit if they have medical complications. I can agree with your posted article in outpatient settings, but if you really work ER you know the reality of this.

With a doctorate, you're either a PharmD, DPT, DNP, or you have a non-healthcare doctorate.

Negative stereotypes and biases absolutely affects the care of patients in the ED, inpatient, and outpatient! It is not mitigated by consulting psych and neuro.

The article literally said, “For example, people with comorbid mental illness and diabetes who presented to an emergency department, were less likely to be admitted to hospital for diabetic complications than those with no mental illness.”

That’s just one example. They’ve referenced the study if you want to read it. I’m sure you can do a pubmed search to find others if you’re interested.

 

[chicandtoughness]

I don't deny that negative stereotypes and biases permeate all LOCs. But in the ED the docs defer to the specialists to rule out MH issues, and then the physical symptoms are managed. That's not poor care, that's thorough care and that's ruling out any issues or psychosomatic sxs that may be 2/2 an MH primary. I suspect there is some sampling bias here too- a patient presenting with schizophrenia and DM complications probably is not the most reliable reporter of his sxs. I find it hard to imagine that someone with DM complications and GAD, for example, is not being admitted for appropriate medical care. And of course, someone who is very clearly in danger (low O2, head trauma, whatever) will get treated regardless of their MH concerns.

I only know what I know, and I've worked both in med ED and psych ED. Is it representative of all places? Nah. But a blanket statement that folks are not being treated properly because of their MH issues is not true.

 

[genop]

But in the ED the docs defer to the specialists to rule out MH issues, and then the physical symptoms are managed.

That is most certainly NOT what happens in my experience. If a patients presents to the ED with a mental health issue, then yes. Psych will be consulted. If they present to the ED with a medical issue and have a history of a psychiatric disorder, the ED docs are not getting psych consults to rule out MH issues. They’re especially not waiting to address the physical symptoms until that happens. They address the medical needs, stabilize the patient, discharge or admit.

I don’t think I’ve ever even seen a psychiatrist come to the ED. I don’t work at a psych ED though. It might as well be, with as many psych patients we get.

 

[genop]

I suspect there is some sampling bias here too- a patient presenting with schizophrenia and DM complications probably is not the most reliable reporter of his sxs. I find it hard to imagine that someone with DM complications and GAD, for example, is not being admitted for appropriate medical care.

I think we need to remain intellectually curious instead of assuming or dismissing valid concerns, especially ones backed by research and widely known to be a problem. It would be helpful to be cognizant of confirmation bias, too.

Here’s the link to the abstract of that study. Link to the full text is also available.

Disparities in hospitalization for diabetes among persons with and without co-occurring mental disorders - PubMed

This study provides more evidence demonstrating disparities in physical health treatment for persons with co-occurring mental disorders. Persons with diabetes and anxiety or depression appear to be at greatest risk in this service setting. Further research is needed to identify persons with...

pubmed.ncbi.nlm.nih.gov

Per the abstract, they did differentiate between patients with psychotic disorders vs patients with non-psychotic disorders like depression and anxiety. Here is part of their conclusion:

“This study provides more evidence demonstrating disparities in physical health treatment for persons with co-occurring mental disorders. Persons with diabetes and anxiety or depression appear to be at greatest risk in this service setting.”

I know it can be unpalatable to think that people are more likely to be treated poorly if they have a mental illness (or if they’re a minority), but we can’t ignore problems because we find it unpalatable.

 

[genop]

@chicandtoughness Full disclosure: Per my own confirmation bias, I didn’t read the full study since it already supports my current position and years of experience working in healthcare. 😂 I probably will later. I know we’re not supposed to base any conclusion off of abstracts. Feel free to read the full article. Had there been a study to conclude the mentally ill are not being treated differently than people without mental illness, with subsequent denial of health disparities, I would analyze the hell out of that study. Lol. Because I know for a fact it’s not true. There have been too many cases that I’ve personally witnessed. I’m not talking about a one off here and there. I’m talking consistent and regular witnessing of discriminatory behavior and poorer care towards the mentally ill and other stigmatized groups.

That’s another reason why I’m against always dismissing anecdotal evidence. It depends on how common the anecdotal experience is and how critically people have evaluated the situation, and considered other factors at play. A lot of times, anecdotal evidence leads people to come up with hypothesis and theories, and test them via randomized controlled trials.

I and others had repeatedly witnessed discrimination and bias against people with mental illness. People with mental illness have recounted their own experiences of it as well. Before it was studied, I’m sure some would have just dismissed the issue saying it’s just anecdotal. People are being dismissive and refusing to believe it even with studies. 😩

Edited to add: That diabetes study that I posted the abstract to had significant flaws. I briefly read through the whole thing and the flaws were glaring. For example, they did not even properly assess acuity and need for hospitalization in order to compare group differences. There were also significant sex differences between the groups. The non-psychotic mental illness group had significantly more females compared to other groups…This is why we were always taught not to go off of abstracts! Lol.

 

[chicandtoughness]

That is most certainly NOT what happens in my experience. If a patients presents to the ED with a mental health issue, then yes. Psych will be consulted. If they present to the ED with a medical issue and have a history of a psychiatric disorder, the ED docs are not getting psych consults to rule out MH issues. They’re especially not waiting to address the physical symptoms until that happens. They address the medical needs, stabilize the patient, discharge or admit.

I’m a little confused. You just gave me an abstract and spent time elaborating on how medical concerns are not being addressed properly because providers are prioritizing mental health illnesses over physical illness, therefore perpetuating bias towards psychiatric concerns. And then gave me anecdotal evidence that that is NOT what is happening. So where is the issue?

From what I’ve seen in practice, my docs have always ordered everything at once, so the patient just sits there waiting for imaging/labs/psych consult and whatever happens first, happens first. Obviously if it’s a true emergency then stabilization happens, but I also worked nights and you know the number of folks who malinger… so we had a lot of psych consults called lol.

That’s another reason why I’m against always dismissing anecdotal evidence. It depends on how common the anecdotal experience is and how critically people have evaluated the situation, and considered other factors at play. A lot of times, anecdotal evidence leads people to come up with hypothesis and theories, and test them via randomized controlled trials.

I agree with you, and I’m not dismissing the fact that SDOH/disparities are at play- that’s actually a big part of my own research studies and the reason I went into healthcare to begin with. I’m sure this also varies widely from geography to geography and setting to setting; without doing a deep dive into literature I can only speak to my anecdotes, which are as I’ve presented above.

 

[clausewitz2]

That is most certainly NOT what happens in my experience. If a patients presents to the ED with a mental health issue, then yes. Psych will be consulted. If they present to the ED with a medical issue and have a history of a psychiatric disorder, the ED docs are not getting psych consults to rule out MH issues. They’re especially not waiting to address the physical symptoms until that happens. They address the medical needs, stabilize the patient, discharge or admit.

I don’t think I’ve ever even seen a psychiatrist come to the ED. I don’t work at a psych ED though. It might as well be, with as many psych patients we get.

You have never spent any time in an academic medical center, in that case

 

[WisNeuro]

You have never spent any time in an academic medical center, in that case

Or any VA hospital, or non-profit hospital in a downtown area, or etc.

 

[smalltownpsych]

I have helped patients improve despite broken systems and negative societal factors and overwhelmeing environmental factors. I have always seemed to get the ”hopeless cases” and I’m always foolish enough to think that I can help or make a difference. I get frustrated with bad care and dysfunctional systems and criticize it all day long, but I also realize that I need to focus on what I can do. If I focus too much on the problem I actually end up contributing. Took me a while to figure that one out.
One of my favorite cases was helping a couple with fairly low IQ living in poverty and dealing with multiple layers of negative environmentAl stressors. I worked with each of them individually for a couple of years and they lost 100 pounds, stopped having chronic pain and relying on opiates for that, stopped having agoraphobia as in they looked forward to going out and doing things, and chronic, stable depression became a relic of their past. I didn’t target any of those problems directly and remarkable things happened. That’s why I love good psychotherapy.

 

[genop]

You have never spent any time in an academic medical center, in that case

Currently work at one of the top AMCs.

 

[genop]

Or any VA hospital, or non-profit hospital in a downtown area, or etc.

Haven’t worked at VA, but have worked in a non-profit hospital in a downtown of major metropolitan area.

 

[Sanman]

Haven’t worked at VA, but have worked in a non-profit hospital in a downtown of major metropolitan area.

Given your personal views regarding society, I am surprised you haven't chosen to work in the only socialized medical system in the U.S. (that doesn't require joining the military).

 

[genop]

Given your personal views regarding society, I am surprised you haven't chosen to work in the only socialized medical system in the U.S. (that doesn't require joining the military).

I would go insane at the VA. Lol.

And thanks for being civil and not resorting to personal attacks. I always look forward to reading your responses.

I’m amused that people who are not working in medical EDs are invalidating my experience of working in them for years. 😂

I’m trying not to let the behavior of some of the psychologists in these threads taint my image of psychologists as a whole. Their behavior and the way some of them interact and attack people is not a good look. I would not feel comfortable having patients go to people like that for any type of care.

 

[Sanman]

I would go insane at the VA. Lol. I just can’t do it.

That's okay, they have locked units and you will already be in the building. Very convenient.

 

[Freud’sMommy]

I don’t feel comfortable sharing what kind of healthcare professional I am, but I have a doctorate. You don’t have to believe me.

I was using professional terms, but there’s not established pathophysiology behind most of these mental health diagnoses. Therefore, I can’t talk about it the same way one would talk about the pathophysiology of cancer.

In my original post, I made it clear that I was posting my thoughts and opinions, not primary literature or a journal club presentation.

DNP.

 

[clausewitz2]

I would go insane at the VA. Lol.

And thanks for being civil and not resorting to personal attacks. I always look forward to reading your responses.

I’m amused that people who are not working in medical EDs are invalidating my experience of working in them for years. 😂

I’m trying not to let the behavior of some of the psychologists in these threads taint my image of psychologists as a whole. Their behavior and the way some of them interact and attack people is not a good look. I would not feel comfortable having patients go to people like that for any type of care.

I am a psychiatrist, it turns out, and I have showed up professionally in medical EDs on many occasions, at least in residency. C&L work is a required part of our training in order to maintain ACGME accreditation. If you work in a top AMC and haven't seen psychiatrists come to the ED, you are not looking very hard.

 

[clausewitz2]

I am a psychiatrist, it turns out, and I have showed up professionally in medical EDs on many occasions, at least in residency. C&L work is a required part of our training in order to maintain ACGME accreditation. If you work in a top AMC and haven't seen psychiatrists come to the ED, you are not looking very hard.

The alternative perhaps is that OP works in a system with a psychiatric ED so efficient and capacious that all possible MH difficulties are whisked away to it before being seen by most ED staff. Our system was pretty well-organized in this regard but even we did not achieve perfect filtering. I would be interested to know how the miracle is performed.

 

[WisNeuro]

I would go insane at the VA. Lol.

And thanks for being civil and not resorting to personal attacks. I always look forward to reading your responses.

I’m amused that people who are not working in medical EDs are invalidating my experience of working in them for years. 😂

I’m trying not to let the behavior of some of the psychologists in these threads taint my image of psychologists as a whole. Their behavior and the way some of them interact and attack people is not a good look. I would not feel comfortable having patients go to people like that for any type of care.

Or perhaps it's that many people, who have indeed worked in EDs, have had a much different experience than you. You seem to think your anecdotal, if even true, experience, is the only way that healthcare works in the US.

 

[genop]

You seem to think your anecdotal, if even true, experience, is the only way that healthcare works in the US.

Point to when I said that. If anything, you are projecting again. You guys have invalidated my experiences time and time again, and acted like you know everything. Even in your post you said, “if even true.” What is that supposed to mean? That I’m lying? 🙄 Please work on your issues. I wish you the best.

 

[genop]

ED physicians are not waiting for psych to see and rule out MH issues in ED patients presenting with medical issues (even those with history of psych problems), and then treating their medical issues. They’re prioritizing the medical issue that brought the patient to the ED and addressing that. If they determine the issue is psychiatric in nature, then they may consult psych.

 

[WisNeuro]

Point to when I said that. If anything, you are projecting again. You guys have invalidated my experiences time and time again, and acted like you know everything. Even in your post you said, “if even true.” What is that supposed to mean? That I’m lying? 🙄 Please work on your issues. I wish you the best.

It means that your understanding of healthcare, even at a basic level is so lacking in sophistication and nuance, that it's hard to believe that you actually work in healthcare, even at the midlevel.

 

[genop]

It means that your understanding of healthcare, even at a basic level is so lacking in sophistication and nuance, that it's hard to believe that you actually work in healthcare, even at the midlevel.

I actually feel that way about you and some of the others. For example, the fact that some of you think ED physicians wouldn’t address a patient’s medical problems until a psychiatrist comes and rules out MH issues is shocking.

The fact that some of you are acting like a lot of my other comments are controversial and wrong when they’ve been well-established to be true is also shocking. Especially when other psychologists and psychiatrists on SDN and outside of SDN have said the same thing. When it’s happened on SDN in the psychology and psychiatry threads, they haven’t been attacked the way I have. I’m not even going to start on the straw man arguments, reading comprehension issues, disrespect, and condescension I’ve witnessed.

I wish you well.

 

[WisNeuro]

 

[genop]

I have compassion for you. This is not the behavior of a happy, well-adjusted individual. I don’t know who hurt you or what you’re going through in your life that makes you behave this way. I genuinely wish you happiness (not at other people’s expense) and healing.

 

[chicandtoughness]

I actually feel that way about you and some of the others. For example, the fact that some of you think ED physicians wouldn’t address a patient’s medical problems until a psychiatrist comes and rules out MH issues is shocking.

You twisted our words so hard with this I don’t know where to start.

First you post a paper and back it up with your opinion that people presenting to the ED with medical + psychiatric issues are not having their medical issues properly addressed, insinuating that EDs are biased towards dealing with psych issues first. The thesis of that paper being that medical issues are being missed because psych is being considered first at the expense of medical issues.

Later, you backtracked and said that no, actually, people coming into the ED never see a psychiatrist, and that the lack of attention to mental health issues is the problem.

I also more or less agreed with you initially but also pointed out that triage is an important art. So if you have a patient who is actively psychotic and also reporting a bunch of somatic symptoms, well, the EM doc will probably call for a psych consult to rule out any complications. Doesn’t mean they aren’t stabilizing and ordering other things (imaging, etc) if necessary, but if the doc places psychiatric issues high on the problem list/ddx then yeah, psych is going to get called for consult. I specifically pointed out that both medical and psych issues are addressed, and that if someone is coming in with a more acute issue like afib, then duh, we will stabilize first and then call for psych/neuro.

You then told all of us you never see psychiatrists come to the ED, which was a strong enough statement for many people to call you out and say this is NOT the case in many of our experiences. You’ve been the one constantly strawman-ing, presenting poor arguments, asking leading questions, and then turning around and accusing others of exact the same thing. You griped at us that your anecdotes were not being respected, but when others provided their anecdotes you were quick to call us liars and attackers.

EDIT: removed this last sentence because it was admittedly very rude and I apologize. Ad hominem attacks are not cool.

 

[chicandtoughness]

ED physicians are not waiting for psych to see and rule out MH issues in ED patients presenting with medical issues (even those with history of psych problems), and then treating their medical issues. They’re prioritizing the medical issue that brought the patient to the ED and addressing that. If they determine the issue is psychiatric in nature, then they may consult psych.

Reread my posts. I said if someone comes in with concurrent psych and medical issues then usually a psychiatrist is called for consult. I gave examples of when psych might be prioritized, and then examples of when medical might be prioritized.

But surely in your training you know if someone is presenting for an CC of abdominal pain but also reports an MDD dx in the PMH you’ll at the very least run a PHQ-2 or -9 by em, right? And if needed then the first couple questions of a CSSRS? That’s not mental health bias, that’s just CYA.

Especially if you’ve worked nonprofit downtown of a large metro area, you know half of those patients are malingering so you sit em down, ensure them we will get a head X-ray to check out the poorly defined diffuse pressure they feel in their face, and then call psych because Mr. Smith is once again reporting he’s seeing shadows telling him to go flip some tables in the coffeeshop.

It’s not either/or, and it doesn’t happen one way or the other every time.

 

[AcronymAllergy]

Mod Note: Proactive friendly reminder to everyone to please keep discussions/comments civil and professional, even when we disagree with one another. Thanks.

 

[WisNeuro]

 

[cara susanna]

I would go insane at the VA. Lol.

And thanks for being civil and not resorting to personal attacks. I always look forward to reading your responses.

I’m amused that people who are not working in medical EDs are invalidating my experience of working in them for years. 😂

I’m trying not to let the behavior of some of the psychologists in these threads taint my image of psychologists as a whole. Their behavior and the way some of them interact and attack people is not a good look. I would not feel comfortable having patients go to people like that for any type of care.

I don't love when people say stuff like this - we obviously don't act the same way with patients that we do on a (technically anonymous) message board with our peers.

 

[genop]

You twisted our words so hard with this I don’t know where to start.

First you post a paper and back it up with your opinion that people presenting to the ED with medical + psychiatric issues are not having their medical issues properly addressed, insinuating that EDs are biased towards dealing with psych issues first. The thesis of that paper being that medical issues are being missed because psych is being considered first at the expense of medical issues.

Later, you backtracked and said that no, actually, people coming into the ED never see a psychiatrist, and that the lack of attention to mental health issues is the problem.

I also more or less agreed with you initially but also pointed out that triage is an important art. So if you have a patient who is actively psychotic and also reporting a bunch of somatic symptoms, well, the EM doc will probably call for a psych consult to rule out any complications. Doesn’t mean they aren’t stabilizing and ordering other things (imaging, etc) if necessary, but if the doc places psychiatric issues high on the problem list/ddx then yeah, psych is going to get called for consult. I specifically pointed out that both medical and psych issues are addressed, and that if someone is coming in with a more acute issue like afib, then duh, we will stabilize first and then call for psych/neuro.

You then told all of us you never see psychiatrists come to the ED, which was a strong enough statement for many people to call you out and say this is NOT the case in many of our experiences. You’ve been the one constantly strawman-ing, presenting poor arguments, asking leading questions, and then turning around and accusing others of exact the same thing. You griped at us that your anecdotes were not being respected, but when others provided their anecdotes you were quick to call us liars and attackers.

EDIT: removed this last sentence because it was admittedly very rude and I apologize. Ad hominem attacks are not cool.

Nope. You’ve got it completely wrong. You can reread my posts.