When Will the Medical Field Start Responding Appropriately to Mental Issues?
Having just read an article on Medscape titled “Nonpsych Hospitalizations Risky for Those with Mental Illness” I am nothing short of enraged. It is not the content of the article that enrages me as much as why the problem exists. Yes, mentally Ill patients have higher mortality, more complications, more untoward events and higher death rates.
As someone with 40 years of experience in the field, I’d like to see the causes of the problems addressed and some fixes implemented – or at least suggested – neither of which has happened. What do I see as the causative issues?
- There are not enough psychiatrists to treat even those in the psych hospitals and the doctors’ offices much less to do Consult Liason work, and that is partly because although we are the primary caretakers of emotional illness, the pay steadily drops lower and lower and doctors are trained to spend more time medicating and less time talking to the patients just to support their office and themselves. Time is also an issue, as it requires going to an additional site to see patients
- It is nearly impossible to get hospitals to create units that care for patients that have combined physical and psychiatric issues, and the constraints placed by credentialing organizations are such that potentially dangerous things like IV’s and catheters and oxygen and such are not allowed on psych units because patients might harm themselves or someone else with them, making it impossible to treat medical issues on a purely psychiatric unit.
- Close to 90% of psychiatric drugs are dispensed by non- psychiatrists who usually dispense the most recent drugs delivered as samples by the pharmaceutical reps.
- Most other doctors don’t understand and/or feel comfortable with psych patients.
- When a consult is called for they almost always want it immediately, which is not practical given the other demands on the psychiatrist, and most other specialties almost never come to a psychiatric unit to consult and that is usually after a lot of pleading
- Although the treating in-patient doctor often STOPS a patient’s psychiatric meds WITHOUT talking to the treating psychiatrist or the family, they usually do so without knowing about withdrawal issues, and interaction issues, and yet when asked to START some other medicine, they don’t want to sign an order for that.
- Too many doctors do not look at drug side effects and drug interactions, much less drug withdrawals, and are not aware of the mental side effects that can be caused by many, many meds from all areas of the treatment spectrum.
- Doctors these days are under tremendous time pressure to see more patients for less time and to spend more time completing electronic records which, if done properly would be of great benefit, but most of them are a disaster – being complicated to interact with and full of useless data. This is an issue for the very young tech-saavy physicians as well as older ones who are less so.
- Psychiatric assessment remains much more difficult than other areas of medicine because of the relative scarcity of diagnostic tests that help identify what is going on, although that is improving considerably over time.
- It is crucially important for more time to be spent teaching about the mind-body interface. Over the years we have found many things – strokes, tumors, infections, endocrine disorders and other medical issues, as well as various chemicals taken for treatment or used for abuse – that can cause those changes in mental function that then look like – or even cause ‘mental illness’ – ie, the brain is not working the way one would normally expect it to. It is equally important to understand how when people are under adequate emotional duress and lack adequate means for resolving it for what ever reason, that can present as a ‘medical illness’ and that illness is often resistant to a wide variety of medical treatments that are thrown at it.
- If I could redesign medical education, I would start with at least a full year of immersion in learning about the brain and emotions and how they work, and spending time around the ‘mentally ill’ and getting to know their stories. Once the diverse powers of the mind were better understood would be the time to start studying physical illness, and then look for ties as well into emotional ties to it. One can even look at many ‘accidents’ and recognize an unconscious set of behaviors at work that may tie into things.
- Ironically, I did my first residency in Pathology, and after seeing specimens from people who were sick enough to have things removed – but those things turned out to be normal – I recognized there was a lot more to be learned. The work of people like Dr. Bernie Siegel, who had cancer surgery patients undergo spontaneous remission just before they were to have surgery speaks volumes about the power of mind and emotion over the wellness of the body.
It is time to get over stigmatizing our emotions and recognize how vital they are to everything we do and treat them and ourselves with the appropriate respect if we are going to start healing more people and reverse the trend of more and more people dying from suicide and substance abuse, and now these episodic terrorist attacks.