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Thread: The treatment of mental health patients by medical doctors.

  1. #1
    I am a gerbil wrangler. lastdefense's Avatar
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    The treatment of mental health patients by medical doctors.

    Hello

    I would like to put together a book with both facts and personal stories (I'm hoping from patients and doctors) relating to how psychiatric patients are treated by non-psych doctors. (Edit: The stigma given to them regarding treatment - Thank you LJD!!) I was referred here for help with finding out if this has been done (or over done) before. I'm currently checking the web and found a couple of short articles - but I have to admit that my Google-Fu is not very strong.

    I would also love any research tips. This is my first project of this kind.

    Thanks in advance!!
    Last edited by lastdefense; 02-02-2013 at 12:26 AM. Reason: Added clarification

  2. #2
    empty-nester! shadowwalker's Avatar
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    I was lucky enough never to have to go to a non-psych doctor, but I heard a lot of horror stories, everything from being prescribed anti-depressants without any more evidence of clinical depression than someone feeling bad, to clients being told to quit feeling sorry for themselves. I wish you luck with the book - be good to bring this problem to light.
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  3. #3
    Blissfully Clueless Mutive's Avatar
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    Generally, a good non-psych doctor will recommend someone who is exhibiting what appears to be a metal health problem to a psychiatric physician. General practitioners (and others who do first line treatment, such as ob-gyns) are invaluable for their ability to do things like say, "Huh, you're getting angry more easily, having a hard time sleeping, and gained 20 lbs. over the last 6 months. There's no non-psychiatric underlying medical condition spotted on the blood tests, so let me send you over to Dr. Psych, my colleague who specializes in this stuff."

    Of course, not all general practitioners are *good*. But in theory, their training should be sufficient to say, "This looks psychiatric, let's send him/her to the appropriate specialist." (Similarly to how if they spotted a heart problem, they might send the patient to a cardiologist.)

  4. #4
    volitare nequeo AW Moderator veinglory's Avatar
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    What are you looking for in particular? Every person has a GP. For psychological issues they will refer to a specialist generally, and just keep any related records in their files. They would track the condition and monitor for any side effects of medication. That would be the norm.

    Then there are the cases of doctors who are no good and do various things incorrectly.

  5. #5
    practical experience, FTW LJD's Avatar
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    American examples, specifically?

    Here (Ontario), I would say, in contrast to the above comments, it is not the norm to be immediately referred to a psychiatrist. That would happen if the problem is severe, or it hasn't responded to treatment. From what I've been told from a few doctors and med students, psychological problems are often a sizeable fraction (~30%) of a family doctor's practice. Also, the wait times to see a psychiatrist here can be ridiculously long, and if you don't live in a major city centre, well, good luck on ever seeing one. So a referral might not do you any good in the near future anyways. It might also just be a one-off consult, and the psychiatrist would send recommendations back to your family doctor. (Similarly, an ob-gyn doesn't provide first-line treatment here. Most women would see their family doctors for things like pap smears, and would be referred to an ob-gyn if there is a problem.)

    My experience with family doctors has pretty much been "Yeah, you're depressed." (No shit, I'm depressed.) "Here's a prescription for an anti-depressant. Make an appointment for about a month from now."

  6. #6
    I am a gerbil wrangler. lastdefense's Avatar
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    As far as doctors doing what they can within their specialty - I'm talking about doctors who refuse to even acknowledge you could have a physical problem, simply because you're a mental health patient. In my personal experience I suffered with C.diff (and on a lesser note, a Vitamin D deficiency) for two months longer than necessary because without even knowing me the doctor had decided that if I was on psych meds I couldn't know what was going on in my own body. I had to fight for tests and in the end it was another doctor (in another clinic) who diagnosed me.

    LJD - Definitely not just American views. I'm looking for views from all over. I definitely don't think that it's an American problem.

  7. #7
    practical experience, FTW LJD's Avatar
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    Quote Originally Posted by lastdefense View Post
    As far as doctors doing what they can within their specialty - I'm talking about doctors who refuse to even acknowledge you could have a physical problem, simply because you're a mental health patient. In my personal experience I suffered with C.diff (and on a lesser note, a Vitamin D deficiency) for two months longer than necessary because without even knowing me the doctor had decided that if I was on psych meds I couldn't know what was going on in my own body. I had to fight for tests and in the end it was another doctor (in another clinic) who diagnosed me.
    So you are interested in the stigma of mental illness within the medical profession? (This was not clear from your OP.)

  8. #8
    empty-nester! shadowwalker's Avatar
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    While hospitalized in a mental institute, I had horrible headaches. The doctor (non-psych) kept telling me it was because of the depression (big DUH) and I had to get the advocate involved just to get medication for it. Hard to work on mental health issues when your head is exploding, but try to tell that schmuck anything. And this was in the US. I don't think stupidity has national boundaries.
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  9. #9
    practical experience, FTW mayqueen's Avatar
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    There's been a lot written on so-called contested illnesses (illnesses that aren't accepted by the medical profession uniformly as "real") like fibromyalgia, chronic fatigue syndrome, etc. Most of these conditions are dismissed as being mental health problems. Is that sort of what you're looking for? If so, I can point you to some books and articles. Just PM me.

    (I'm a medical sociologist, and contested illnesses are in my wheelhouse of research interests.)
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    ~~~~*~~~~ backslashbaby's Avatar
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    Quote Originally Posted by lastdefense View Post
    As far as doctors doing what they can within their specialty - I'm talking about doctors who refuse to even acknowledge you could have a physical problem, simply because you're a mental health patient. In my personal experience I suffered with C.diff (and on a lesser note, a Vitamin D deficiency) for two months longer than necessary because without even knowing me the doctor had decided that if I was on psych meds I couldn't know what was going on in my own body. I had to fight for tests and in the end it was another doctor (in another clinic) who diagnosed me.

    LJD - Definitely not just American views. I'm looking for views from all over. I definitely don't think that it's an American problem.
    My last switch from a doctor was because of this problem, but it was at a teaching hospital and I was getting sick of paying premium bucks for med students to be my GPs anyway, honestly.

    I had symptoms that looked like hyperthyroidism (especially a really high pulse rate) and the docs said it was probably because of my antidepressant. I've been on antidepressants for decades and hadn't changed anything about mine. I have a feeling they thought it might be anxiety-related once they saw that antidepressant on my list of meds.

    I found a great new GP out of it The endocrinologist I called and saw for the symptoms also doubles as a family doctor, so I'm glad it went the way it did

    If you need the diagnosis, it seems to be related to a connective tissue disorder I have (Erlicher-Danlos), and going on extended-release propranolol fixed it all very well.
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  11. #11
    volitare nequeo AW Moderator veinglory's Avatar
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    Quote Originally Posted by lastdefense View Post
    As far as doctors doing what they can within their specialty - I'm talking about doctors who refuse to even acknowledge you could have a physical problem, simply because you're a mental health patient. In my personal experience I suffered with C.diff (and on a lesser note, a Vitamin D deficiency) for two months longer than necessary because without even knowing me the doctor had decided that if I was on psych meds I couldn't know what was going on in my own body. I had to fight for tests and in the end it was another doctor (in another clinic) who diagnosed me.

    LJD - Definitely not just American views. I'm looking for views from all over. I definitely don't think that it's an American problem.
    Honestly, it sounds to me like your doctor sucks and you need a new doctor. I have not had this kind of problem over a range of different GPs in three countries. Some doctors are lazy and try to explain problems away, not just in this way but in all sorts of ways.

  12. #12
    I am a gerbil wrangler. lastdefense's Avatar
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    Quote Originally Posted by LJD View Post
    So you are interested in the stigma of mental illness within the medical profession? (This was not clear from your OP.)
    Yes Thank you for phrasing it much better than I did!

  13. #13
    I am a gerbil wrangler. lastdefense's Avatar
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    Quote Originally Posted by veinglory View Post
    Honestly, it sounds to me like your doctor sucks and you need a new doctor. I have not had this kind of problem over a range of different GPs in three countries. Some doctors are lazy and try to explain problems away, not just in this way but in all sorts of ways.
    I definitely know that good guys are out there! And I've met some. But I have encountered more of the bad guys. It may be a military thing. My husband is active duty and my first visit is to a military doctor. But I've also heard of non-military who have had similar problems. To include some of the people who have posted in this thread. Honestly, I'm terrified to see someone new these days (on base or off) because I don't know what I'm in for.

  14. #14
    I am a gerbil wrangler. lastdefense's Avatar
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    Quote Originally Posted by shadowwalker View Post
    While hospitalized in a mental institute, I had horrible headaches. The doctor (non-psych) kept telling me it was because of the depression (big DUH) and I had to get the advocate involved just to get medication for it. Hard to work on mental health issues when your head is exploding, but try to tell that schmuck anything. And this was in the US. I don't think stupidity has national boundaries.
    This is what I mean. It's as if you cannot be both mentally and physically unhealthy at the same time. I've been turned away with a sinus infection from a doctor who insisted I check in with my psychiatrist first O_o

    Thank you, for sharing.

  15. #15
    practical experience, FTW Wiskel's Avatar
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    You've picked difficult topic to research as your interview group is so diverse.

    My research tip is keep the most open mind possible.

    I say this because if you interview 100 people with horror stories about being treated for mental illness when, in their opinion they were physically unwell, your group will contain people who needed physical care and had a bad doctor, some who needed only mental health care but didn't believe that, and some who needed both.

    Telling one from another with only one side of the story will be a challenge.

    I'd suggest looking at some of the studies on bedside manner unrelated to mental health too. It's amazing how much people's opinion of a dotor can change based on whether they were told to stop smoking or lose weight at an appointment, and how a patient can tolerate being told something they don't like much better by a doctor they've got a relationship with compared to one they're seeing for the first time.

    How many times they've seen the doctor in question should be one of your questions for them as well as what they thought of the doctor before

    You should also consider asking how many times a person has changed doctors and the reasons for those changes. You may want to see if there are patterns or know if you're interviewing someone after a one-off experience.

    Any field where bad or unwanted news is given is a minefield of complex interactions between doctor and patient.

    Being told something you disagree with does not always equal bad doctor.

    Being told something you like does not always equal good doctor. I could make all my patients think I was brilliant by agreeing with them . . . for about six months until they started to wonder why they weren't getting better.

    And I'm in the Uk with the nhs and free health care.......under a private health care system is a doctor who lets you pay them thousands of dollars for loads of tests always doing the right thing?

    So many questions with impossible but contentious answers.

    Impartiality is key.

    Craig

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    ~~~~*~~~~ backslashbaby's Avatar
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    I agree with Wiskel, and I'd add to see if you can get the same sort of info about the doctors in the story.

    In mine, they had put down that I had a lower back pain problem when I have a disability due to a problem in the C5-C7 area and see a pain clinic/specialist for the problem. My main physical problem in life, and they couldn't even note the right body part. Oy One of the other docs there who saw me caught that after about a year.

    So I do agree with getting a background on the situation, but there are ways of objectively telling whether the doctor also has some background problems. At least get the files if you can, imho.
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  17. #17
    figuring it all out Lia_joy's Avatar
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    I imagine this issue is significant enough to cover even if it has been done before (it certainly hasn't been done to death if a google & amazon search doesn't immediately come up with a similar book, IMO)

    As far as making sure the stories are credible, I'd suggest collecting as many accounts as you can and using the most obvious ones, where the person went on to get a significant diagnosis from another doctor after being dismissed initially because of mental illness.

    Once you have gathered lots of personal accounts, you might be able to identify patterns. I think it would be interesting if you presented solutions for individuals struggling with this issue (rather than just exposing the issue) whether in the form of how to approach your dr, how to find one who will take you seriously, when to consider that symptoms are related to your mental illness, when to insist on further testing etc.

    my topic, in a way is very similar as I cover healthcare as it relates to pregnancy/birth, mistreatment & abuse during labor, and the medical systems general mistrust of women in making decisions about their own care.
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    volitare nequeo AW Moderator veinglory's Avatar
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    I have moved a lot and I am used to having to 'try out' several doctors before settling on one. Recommendations can help, and seeking GPs with a degree of specialization. I also think those with websites that emphasis holistic/alternative stuff is a good sign. Not that I have any truck with homeopathy etc per se, but it seems to relate to a greater willingness to see me as a person rather than a bag of inconvenient symptoms with a wallet.

  19. #19
    practical experience, FTW Wiskel's Avatar
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    Quote Originally Posted by Lia_joy View Post
    I'd suggest collecting as many accounts as you can and using the most obvious ones, where the person went on to get a significant diagnosis from another doctor after being dismissed initially because of mental illness.



    IMHO, a book looking at how patients with mental illness are treated by the healthcare system is a very different animal than a book editorialising the stories of people who have experienced stigma within it.

    Both could be valid, and I'm not saying one has more merit than the other.

    A balanced book would report on the times patients didn't experience stigma as well. It would contain stories of people who went to the doctor thinking they had physical problems, were given mental health treatment only and made a full recovery. It would encourage people who have mental health problems not to dismiss their doctor's advice when he/she is trying to get them to accept help from mental health agencies.

    A scientific book would attempt to figure out what proportion of people had a positive experience and what proportion had a negative one.

    Nothing wrong with any of those approaches as long as the book is honest about what it is.

    I believe the people who would benefit most from reading these stories though, the people who get it wrong, or people in training are more likely to be reached with a balanced book. The professionals who are getting it right will be more likely to push it and it might be easier to generate good word of mouth.



    Craig

  20. #20
    New Fish; Learning About Thick Skin Doctor J's Avatar
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    Hello! Before I say anything else, I'd like to say I chose my username weeks ago, not just to post on this thread

    I'm a psychiatrist, one of the nice ones, not like H. Lecter. As the OP may know, people with severe mental illnesses (such as schizophrenia) have much worse health outcomes than people without. There are probably a number of reasons for this...
    1. Worse lifestyles; diet, smoking, alcohol, lack of exercise etc
    2. The medications used to treat the illness, which may contribute to weight gain
    3. Some researchers say schizophrenia is a multi-organ disease, which leads to weight gain by itself, and
    4. The stigma issue, as mentioned above, leading to symptoms being attributed to mental illness rather than physical illness.

    Compared to nos 1 and 2, no 4 doesn't have a lot of evidence, but most people working in mental health services will have some anecdotal evidence. I'll give you a story of mine, from about 15 years ago (don't worry about confidentiality - if you can identify anyone from this, your psychic powers would be best put to use as a crime fighting superhero).

    In an A/E (ER), I was called to see a man with known schizophrenia who was having visual hallucinations and had been found wandering. The general doctors thought this was just his mental illness and wanted me to sedate and transfer him to a mental health hospital. But I knew visual hallucinations (seeing things) was unusual, although possible, in schizophrenia. In the end, I convinced them to do a CT scan, and they found a subdural haematoma, a blood clot on the brain, probably from a recent head injury. He stayed in the general hospital and received appropriate treatment.

    You could interpret this as all appropriate - they called the correct professional who did the right thing - or you could interpret it as stigma - they should have had some inkling the man picking at imaginary floaty things could have had something acutely wrong, but didn't even consider it.

    But you were looking for examples

  21. #21
    I am a gerbil wrangler. lastdefense's Avatar
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    Wiskel: A difficult topic indeed! I agree on an open mind. I am seeking both positive and negative experiences. Bedside manner, history with a certain doctor and patients switching up are an excellent place to start with (thank you).
    I'm not arguing against being told something you don't want to hear. More of being dismissed completely - not even getting to the point where the doctor tells you anything (besides to see your psych doctor/it's your depression/anxiety.)
    I also agree that being told what you want to hear is bad as well. And dangerous.
    Being a mental health patient myself I am making a point to put aside the personal when it comes to creating interviews, deciding topics and so on.

    Backslashbaby - I agree with that as well. If it's possibly I would like to talk to both the patients and their doctors - though that's in a perfect world.

    Lia - Thank you so much! You're right, this can't just be about telling people what's wrong and leaving them hanging. There has to be some suggestions, some solutions to the problem.

    Doctor J - Thank you for sharing that story. In that case it makes sense to me that you, a psychiatrist, were called. I have Bipolar and if I went into the hospital full of energy, speaking at a fast pace and offered to help with some patients - I would expect a psych too. The doctors, in any profession, are not all evil. I know that In my experience physical symptoms often get pushed aside in favor of approaching the mental health issue. Just, stuff that seems to obviously not be mental health related. I also compare my experiences before I got on meds and after and notice a difference.

    I really appreciate you all replying to me. It means a lot and your thoughts, ideas and suggestions are a huge help to me

  22. #22
    Straw-fed HarryHoskins's Avatar
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    Quote Originally Posted by lastdefense View Post
    I would like to put together a book with both facts and personal stories (I'm hoping from patients and doctors)
    Hmmm.

    Quote Originally Posted by lastdefense View Post
    Relating to how psychiatric patients are treated by non-psych doctors. (Edit: The stigma given to them regarding treatment)
    Needs rewording.

    Quote Originally Posted by lastdefense View Post
    I was referred here for help
    Ironic.
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    The mean one AW Moderator Cath's Avatar
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