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CPSI Share                                                  
Public; Provider; Leader
4/30/2018 6:00 PM

What's it like to be ignored?  To ask for help, be dismissed and sent home?  Or fear the consequences of asking for help, so remain silent?

One night in 2015, my mother was sent to the Emergency Department (ED) as a result of a fall.  Mom had a history of breast cancer; and also mental illness.  A spinal tumour had created numbness in her leg causing her to fall; and she had intense back and shoulder pain.  Like many seniors, mom had co-morbidities which impacted her interactions with the healthcare system – schizophrenia was one.

Despite mom's physical symptoms, she was diagnosed with a 'psychotic break' and a Form 42 was issued.  Yet, mom could tell me who I was, where she was, and that she'd come to the ED because she'd fallen. When my sister had taken mom to her family doctor the previous day there were no signs of psychoses; yet, they were holding her for 72 hours as a violent threat to herself. We lost confidence that the hospital would pay attention to mom's acute medical needs without constant advocacy.

When mom had to use the washroom, we asked the nurse for a wheelchair. The nurse said mom could walk herself. Mom returned from the washroom in tears, in a wheelchair accompanied by the nurse, now sheepish. Mom said she had fallen again. We learned that mom had also fallen in the ED the night before and hit her head. The hospital took an x-ray which showed the cancer on mom's bones. The hospital later disclosed, the x-ray was done because mom fell in the ED; not because of the physical symptoms.

The shoulder pain mom had been experiencing was on the same side as her previous breast cancer. X-rays showed her shoulder was broken several times as a result of bone tumour. But we were told oncology wouldn't proceed with treatment until the 'form' was removed. When the psychiatrist arrived 72 hours after mom was admitted, he couldn't explain why mom had been formed. 

We learned that mom had visited the ED in immense pain three times just 11 days prior to the fall. The medical history on her patient chart read, arthritis, high cholesterol, breast cancer, and schizophrenia. The first admitting physician underlined schizophrenia on her chart. The second admitting physician noted the previous diagnosis of schizophrenia, again with no regard to her previous breast cancer. On two of those visits, instead of diagnostics, a nurse instructed my mom on how to take her medications and sent her home. The third time, after waiting several hours, my mom left without being treated.

My mom had visited her family doctor several times for chronic shoulder and back pain over a number of months before she ended up at the ED. She was prescribed physio and Tylenol 2. The day prior to mom falling, my sister had asked for a bone scan as mom's quality of life had suffered with the pain, but the request was rebuked. 

Our experiences hardened our resolve to advocate for mom, yet we are afraid of becoming 'that family'. When a doctor arrived at the bedside stating mom's MRI showed her spine was clear of cancer, we were astonished as no MRI had been done. When we spoke up, the doctor curtly repeated, "It's clear". We spoke up again. The doctor replied sharply, "the MRI was clear for cancer in her spine." When mom finally had that MRI; they told us that she had extensive tumors in her spine and emergency radiation began soon after. There was no apology.

The pain my mother suffered was real. One night mom was so uncomfortable that she began to sway and pull at the bed rails. I sat helpless while she writhed in pain. When the time came for meds, the nurse quietly said to me that the drug manufacturer had changed the packaging and so they had inadvertently been giving mom half doses of the prescribed painkiller. 

Studies have shown people with mental illness, and specifically schizophrenia, experience a greater disparity in treatment. Yet experiencing mental health stigma in the healthcare system has been described as being worse than living with the mental illness itself, and so many people don't seek out medical help.  Mental health stigma in healthcare impacts patient safety in acute and primary care through the effects of diagnostic overshadowing.

If you had a painful shoulder, sore back and numb leg causing a fall, and a history of breast cancer, how would you be treated? Would you be diagnosed with a mental illness or a spinal compression? Would you be formed?  No one chooses to be mentally ill. Diagnostic overshadowing causes harm to patients and takes away their right to receive appropriate diagnosis and timely treatment.        

Michelle Lindsay
Twitter: @zoekegan