Friday, August 23, 2013

Diagnostic Overshadowing

Story.of.my.life.

When Doctors Discriminate.

The example in the article is bipolar disorder, although I would argue that patients with anorexia face an especially tricky path because of the physical nature of their illness. When an anorexic patient shows up at the doctor's office, it's nearly impossible to determine where the mental illness ends and the physical illness begins—and most non-ED specialists have no clue where to start.

The medical world (in the US, that is) tries its damnedest to keep the body and brain separate, and good luck trying to get treated for a medical issue once you've been labeled a loon. The simple fact of the matter is that patients with mental illnesses are still often seen as willfully deranged, whatever that even means. Stop acting like a crazy person, and we'll stop treating you like one.

Grr. It makes me SO MAD. I went to the student health center on campus once for an EKG because my heart was skipping, and the nurse refused to do it. She saw "anorexia" stamped on my file and told me—this is a direct quote—"We can't help you until you help yourself." That bitch is lucky I didn't, you know, die.

About a year later I went back for a referral to a gastroenterologist because of tummy troubles (and a family history of colon cancer) and was, yet again, dismissed.

It's no use getting bitter about this stuff now, but I guess I'm glad to see the problem acknowledged.

4 comments:

  1. hashtag-- reasons I don't disclose my dx or psych meds. I just don't. Some people who are good at dealing with things, I'll let them know later when/if it feels relevant & I feel safe. The atlantic had another article on mental illness & the stigma. I'm continually surprised at how so many people, in academia & in medicine, don't think that there's a stigma. Maybe the younger generation of people will go into medicine and not act so close-minded, but I don't have high hopes tbh.

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    1. I sometimes do and sometimes don't disclose my history, depending on the doctor and depending on the reason for my visit. I'm lucky enough to be at a university with a fantastic medical school and fantastic faculty/physicians. And in fact, I notice a real difference in tolerance/progressivism about psych issues between university and non-university doctors—maybe because the med school faculty are better networked with other specialties and are more confident and knowledgeable about coordinating care for co-morbids? Just a theory. Anyway yes regardless, there is major stigma and it sucks. I cringe to think about how people struggling with things like schizophrenia are treated, since they are more likely to be seen as straight up "crazy" in the traditional sense, and may be less able to advocate for themselves or determine when they are being blown off.

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  2. I too have a family history of colon cancer and went to the doctor for GI / weird bowel symptoms and was totally dismissed by doctors due to a history of anorexia. "It's diet related I'm sure." "Really? And so food restriction causes blood in your bowels?" (TMI, sorry). I ended up being diagnosed with ulcerative colitis finally, but was dismissed first and had to change doctors twice before someone didn't blame my symptoms on a history of AN...

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    1. wow, that's pretty awful. It must just be so much easier for doctors to assume the ED is the culprit (and to be fair, it probably often IS to blame!) and not want to get involved with someone they presume to be unstable or unworthy of attention. Why should a doctor want to waste resources on someone who made herself sick in the first place by not eating, right??! It's a huge problem, and a really scary one too. I'm glad you were able to get the right diagnosis and care.

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