Mentally Ill Have Low Priority In Emergencies

Have you ever felt that your doctor just isn’t listening to you?Now multiply that by a hundred and you will start to understand what happens when a mentally ill person has a serious physical illness.

A news story on a recent study about how patients with a psychiatric diagnosis are prioritized at the bottom of the list when presenting at an emergency room induced a flashback when I was a young and eager resident psychiatrist on ER duty.

I was dedicated and enthusiastic – some said idealistic – and proud of knowledge obtained not without difficulty.  The event I recalled was a 39-year-old schizophrenic man coming in with chest pain and trouble breathing.  Maybe he seemed a little young for a heart attack, but gasping for air, clutching his chest and crying with pain. Serious complaints that ought to be treated seriously until proven otherwise.

Like I often say now, and like I said there the first time — It doesn’t take twenty years of psychiatry school to tell that his problem was not psychiatry.

I finally did get the nurse to hitch him up to the oxygen, something I could not do myself because the vast array of confusing knobs and spouts and hoses on the wall were not things I’d been trained to handle.

I could not get the Emergency Room physician’s attention as he was occupied with some guy with a bum knee.  In fact, I only aroused his ire by interrupting him.

Me – a lowly resident – could only stand glowering menacingly by the open door to his exam room.

I was undeterred by the doctor’s protest that the potential heart-attack patient was a schizophrenic.

Now, many years have passed and I have read lots of articles telling me that the life expectancies of psychiatric patients are far less than those for non-psychiatric patients.

I know why.  I have seen lots of bad side effects attributed to psychotropic drugs. Alas, in some cases, these drugs are often still necessary, especially for the floridly psychotic monsters.  The benefits of quality of life outweigh the potential risks of living years of hell-on-earth.

That is not an excuse. That is part of the doctor’s medical-ethical dilemma that requires us to be part Solomon and part Hippocrates.

In today’s Medicine-As-Business-And-Politics atmosphere, the quality and longevity of human life is not our gold standard anymore.

I can almost understand the descent of the medical doctor into the position of a functionary, of a not even glorified civil servant, who performs the task at hand without thought of philosophy or ideology.

I am, however, hard put to understand the failure to rush to treat life-threatening conditions.

It is not clear what makes doctors listen.  My only idea is that physicians are increasingly encouraged to see themselves as the cogs in a machine — a poorly oiled and poorly functioning machine at best.

What can you do if you don’t think a loved one is getting needed attention because they have been de-prioritized on account of age, sex, mental status or other factors?

Ask for the administrator, the supervisor, the superior — anyone who may be perceived as above the doctor, who may be actually calling shots.  Such folks are a lot easier to find than they used to be.

The only problem is that if the patient is unable to ask for help — flat on a stretcher, gasping for oxygen or unconscious — there needs to be a family member, some kind of advocate, somebody who cares enough to be bold and demanding.

If there is nobody, we are talking about powerless masses.  And that situation exists in numbers so great that it is a national disgrace.

We are proud people and think that this class of citizens used to exist only in other countries, only far from where we are.  We do not have to look so far now as we may have once thought necessary.

The powerless masses are now all around us. We are becoming them.