Medical professionals : do you take into account a history of diagnosed mental illness when making physical health assessments?

[Hajun]

Or have I just been unlucky?

I have had a catastrophic health issue that I am recovering from. I had to have major surgery. Had it been diagnosed earlier the surgery would have been minor. I went to my GP several times about it but didn't get referred. After diagnosis while awaiting investigation I experienced a complication which I now know is a known complication of this condition, but when I presented to A+E, in intense pain, I was told it was because I hadn't looked after myself properly. This is not true or correct. The complication if it arises at all will do so regardless of what the person with this condition does. It is nothing to do with lifestyle or eating habits or anything else.

I feel that I have not been listened to, in primary care or in A+E, and I wonder if this is because I have a diagnosis of bipolar on my health record. Are medical professionals more likely to not listen to someone with this marker on their notes? Or did I just receive shit care, nothing to do with being A Crazy?

I would appreciate honest answers.

Nobody?

Oh I guess it must be okay then 😐

Um, it’s been 20 minutes…

Im sorry you’ve had such a shit time. It’s not good enough.

Im not a doctor but I am an HCP. I take the mental health history as part of the overall picture, yes. I want to make a hypothesis about what could be happening, and to confirm or deny that by doing various diagnostic tests/treatments. I hope I do t make too many biased assumptions but I’m a human being so it does happen.

A&E isn’t the place for diagnosis really, they’re just trying to prevent you from dying.

You won’t be the first or last to be caught in the ‘if you discuss your symptoms calmly they can’t be very bad; if you scream about them you’re obviously a bit mad’ catch 22. It takes a lot of energy to pursue things via the GP these days but I do think it can still be done - to keep going back.

I’m sorry you’ve been through this @hajun I’m very interested to get HCP perspectives on this too. I think @PermanentTemporary has been very honest with their post. I’m sure there’s probably research on this but it’s a pretty well-known thing anecdotally that accessing healthcare is more difficult if a person has a mental illness on their records. If you’re a woman, there’s also lots of evidence to show that woman’s health concerns are taken less seriously etc. Maya Dusenbery has written about this very well.

I’m a GP. I don’t think a diagnosis of BPAD would influence how I assess somebody presenting with physical symptoms, no - they’re no less likely than anybody else to develop a given medical condition, or to suffer a complication after surgery. If somebody was in an obviously manic state at the time they presented then it could potentially be more difficult to get information from them, but I’m presuming this wasn’t the case for you.

In theory a bipolar diagnosis shouldn't affect your physical health treatment. That said, people with severe mental illness do have worse health outcomes - the reasons for this are quite complicated.

It is impossible to say without knowing more detail, but sometimes it isn't obvious that something bad is brewing eg someone presents with constipation and 2 weeks later is admitted with bowel obstruction. The Gp will have seen dozens of other patients that presented the same and were fine. It doesn't mean that they didn't act correctly at the time.
It might be worth asking for a debrief to see what could have been done differently on both sides.

Tbh I wasn't calm at A+E because I was in a great deal of pain. It was different kind of agitation from the kind of florid aspect I exhibited when I was diagnosed with bipolar but the healthcare staff reactions were very similar to how healthcare staff were at that previous time - soothing and minimalising. I was told that I was in pain because I hadn't eaten that evening, and that it would improve if I had a cup of tea. I hadn't eaten because I was in intense pain and when they gave me tea I vomited immediately, due to being in intense pain.

I have no control sample of course, but I recognise the behaviour because I've seen it previously. I'm not sure that other people presenting with such intense pain with a physical health condition with known possible complications (basically, if you google the initiating condition plus the word "complications" the first ten hits are what happened to me - it's not outlandish) would have been "soothed"/denied treatment to such an extent, when they were vomiting because of said pain.

But I was soothed, cajoled and otherwise told what happened had not, in fact, happened, for four hours.

And for that four hours I was in mind bending consciousness altering agony. I cannot express the experience any other way.

That sounds awful. I haven’t had personal experience but certainly what I have read on here is that NHS doesn’t seem great at dealing with pain-unless you’re at death’s door, pain and other distressing symptoms aren’t prioritised. There’s a thread on here where someone going through back to back labour wasn’t given pain relief for hours, for example. Again, I believe there’s research to show women’s pain is more readily dismissed , and this increases for women of colour

@PermanentTemporary sorry, I was probably not clear. I already (finally) had a diagnosis of the underlying condition when I went to A+E. I had been having tests to determine the extent and was in the middle of that. I got told to go to hospital if things got worse in the interim. They did get a whole lot worse all of a sudden so my neighbour phoned dialled 999, the paramedics assessed me and ran me through to a+e. I handed all my notes about the ongoing investigations over to staff, was left waiting and then this process of soothing began.

I did eventually have major surgery the next day, classed as emergency.

I didn't go to a+e for a diagnosis, I already had a diagnosis. I went there for treatment for a complication.

@HealthyChoicesHard yes as far as I know there are studies showing women's pain is often not seen as clinically relevant. I am a woman so there's that. I'm also a crazy woman though, and I can't help but wonder if that worked against me too.

Don't get me wrong, I kind of understand it. There have been times when people really shouldn't have taken what I said seriously. Eg when I spent all my money and more on paintings that I thought unlocked the secret to the universe (spoiler : they did not), when I emailed my then boss disclosing details of the elaborate international plot against my person (spoiler : there was none) - I absolutely shouldn't have been taken at face value during incidents such as these. But, maybe these episodes disproportionately cloud the judgement of medical professionals when us crazies do genuinely need help with our physical selves.

It happens a lot- not necessarily (always) intensionally but it’s one reason people with severe mental illnesses have poorer outcomes . It’s called ‘diagnostic overshadowing’

Once you had vomited were you taken more seriously ?TBH 4 hours wait ia absolutely standard unless your life is in danger.

No I wasn't taken more seriously! They said that it was because I hadn't eaten properly so had an empty stomach.

In the end what got things moving was one nurse whose face I never saw but I overheard, through the curtain, she had a conversation with the useless god complex doctor who had previously manhandled me. She repeatedly said that she thought I was experiencing the complication that I was in fact experiencing. He repeatedly told her I wasn't, the back and forth went on for some time (I think - I was possibly hallucinating by this point (pain), but I do know that he was an utter out and out bastard, just from the way he examined me). But, God love and save her, she persisted, and in the end it was her who came to see me and said I'd be admitted.

TBH 4 hours wait ia absolutely standard unless your life is in danger.

Without pain relief?

Yes