I’m an experienced psychiatric nurse. I’ve heard thousands of ER stories from patients over the years. Stories about the medical clearance process before admission, treatment for medical issues ranging from minor to life-threatening, from clearly fictional to clearly real. Of course, some have been clearly fake or perhaps psychosomatic – honest mistakes are common in mental health – yet they turned out to be quite real on assessment.
I teach nursing students and I train psych nurses about medical emergency management. I always emphasize a few points:
- In mental health practice, you see more than your share of fictional somatic complaints: lies, drama, psychosomatic issues, and so on. Motives and explanations vary, and we can only speculate much of the time. We’re not mind readers. We need to keep it in mind with every complaint.
- It’s also well-established that people with mental illnesses suffer rather more than their share of real medical issues.
- How best to proceed under such circumstances? I suggest a stepwise minimum process, the bare minimum foundation. To start, ask a few questions to perhaps clarify the complaint. Do the basics: check vital signs, 02 sat, glucose if appropriate, lung sounds, whatever fits the story you’re offered. It takes perhaps two minutes to do the basics. If you uncover anything, follow it up. If not, you focus on the placebo value. It’s not just a pill, folks: placebo is everything we do to make patients feel heard, safe, cared for, important. In the end, fiction or not, you win. Compared to openly dismissing dubious complaints, you uncover some surprises, you build rapport and coöperation, and you save lots of time and energy otherwise spent on distrust and conflict. You’ll also find some medical emergencies before they become emergencies, prevent codes instead of doing codes.
I teach these things because they’re all heavily evidence-based and proven by experience and because they’re not common practice. Stigma and other forms of bias powerfully cloud judgment: that’s what such things do. And stigma is alive and well within health care: why wouldn’t it be? Providers like to think we’re all separate from patients, objective, above it all, but we’re all people, we all exist in our greater culture, saturated with stigma. Of course there’s stigma within health care, even mental health care: there’s stigma wherever there are people. We need to discuss it, not just some places but everywhere it exists, because wherever it exists, it hurts people. It’s not optional.
That all said, here’s the story that triggered this post:
I’d love to hear your thoughts, your stories, your reactions. It’s important to me. It’s important to all of us.