IT HAPPENED TO ME: I Was Given Substandard Treatment in the ER Because of My Mental Illness

All that mattered was that he overheard me say that I had just been hospitalized for my schizoaffective disorder.
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Sarah Dubinsky
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All that mattered was that he overheard me say that I had just been hospitalized for my schizoaffective disorder.

"My stomach's not located there," I told the emergency room physician. "It's higher." I kept pointing upward from my nether regions.

I couldn't fathom why my pelvis would cause nausea and retching, but since the insurance company was paying and the doctor's mind was not changing, I decided to humor him and get the transvaginal ultrasound after he assured me that he would follow up with appropriate non-reproductive testing. It's an invasive test. An ultrasound technician inserts a well-lubricated wand into your vagina, near your cervix, and then jiggles it around.

However, after the ultrasound, he gave me a junk diagnosis that stayed firmly on my crotch. After arguing for more medical treatment for 10 minutes, he still refused to address my abdominal issues, and I was discharged.

I know the difference between my stomach and my pelvis. This doctor either didn't or he didn't care.

I know the difference between my stomach and my pelvis. This doctor either didn't or he didn't care.

It didn't matter to this doctor that I had a nearly normal transvaginal ultrasound test result three weeks before, the findings of which I recited to him. It didn't matter to him that I knew my body and where it ached. All that mattered was that he overhead me tell the medical billing department that I had just been hospitalized for 10 days in the psych ward.

Apparently, the anatomical structure of a crazy woman is reordered. She is no ordinary human. First and foremost, she is centered by her vagina. It is large, loud, and obscures the stomach and any protests. And as most men agree, it is fun to stick things in, like ultrasound wands.

Having established that I have a mental illness, it was easy for him to track it back to my lady parts. He has millennia of medical precedent. A woman's mental health and the condition of her uterus have historically gone hand in hand. If a female was in distress and there were no clearly attributable physical causes, the medical establishment pressed a mental diagnosis of hysteria to minimize these claims. Hysteria is a state of emotional excitability, which is often accompanied by physical symptoms. Since medical testing can easily come up negative, the invalidation by the medical profession can start early.

In this case, the doctor did not even bother to try to diagnose the root of the physical problem, i.e., my stomach. He cast me off due to my mental illness. When my ultrasound report came back nearly normal except for the two small cysts that I had previously informed him of, he refused to treat me further. He gave me Aleve and said that there was no one to complain to about his behavior. A nurse ultimately gave me the hospital administration's phone number. They have not yet returned my calls.

Although this is the most egregious episode, I have been treated this way before — oddly enough by a gynecologist who refused to do a blood test to check my level of hormones when I told him my symptoms tick up before my period. He recommended that I get hospitalized and they could "sort that out." I refused to see him again. I suspect this is not an unusual situation. I've experienced it twice in the last three years.

This breakdown in communication between patients and doctors is a known root cause of hospital "sentinel events," which are unexpected medical occurrences involving death or serious physical or psychological injury, or the risk thereof. Suicide is a sentinel event. When doctors dismiss a woman's physical pain as "mental," overemotional, and hysterical, it can impair a patient physically and emotionally.

I wonder how many mentally ill patients accept condescending behavior as normal and continue to see a doctor that hurts their sense of self or, even worse, drop out from all medical care, believing one bad doctor is indicative of the profession. How many doctors see mental illness as the main problem and gloss over other causes?

There must be a few. The National Alliance on Mental Illness (NAMI), a nationwide mental health advocacy organization, has a training program for physicians so they can respond more appropriately in an emergency situation to those with mental illness. 

However, compassion is hard to teach, and a bad demeanor is not much of a basis for a malpractice lawsuit (and I say this as a lawyer). Unless the lack of treatment caused or contributed to a serious injury or death, I understand that I am basically on my own (and I don't like suing anyway). I could always report the doctor to the State Board of Medical Examiners. I am not sure what would happen, but I assume physicians are generally free to be jerks as long as they can explain their behavior and give the appearance of providing medical treatment.

When I go to a new doctor, I have more things to worry about because I have a severe mental illness. I always hesitate for a moment before I give my list of psychiatric medications. I am on more than the usual antidepressants. While I usually come off as articulate and highly functional, I have to wonder if my complaints will be taken at face value or will they be deemed to be all in my head.

Rightly or wrongly, I expect my actions to be taken as suspect at some level. If I self-diagnose myself (I am used to reading medical records and researching conditions as part of my profession), I must gently lead some doctors down the bunny trail of a correct diagnosis by laying out and grouping my symptoms. The last thing I want is to be labeled a kooky hypochondriac who somehow just happens to be right. That can follow you on medical records.

Still, I have a wonderful relationship with my primary care physician. I recommend her to everyone. She can tell the difference between my stomach and pelvis.

However, I will not fall victim to gaslighting in the emergency room. I will not pretend my physical pain is anything other than real.