A few days ago, my family doctor had sent me into hospital because of worsening shortness of breath. I wasn’t overly surprised when I was met with stigma in the ER. It seemed like the ER doc took one look at my list of psych meds and wrote me off as “just” a psych patient. He barely listened to anything I said, and kept asking what the point was of my GP sending me in. All he wanted to do was repeat the tests my GP had ordered and refer me to an outpatient clinic. I was frustrated with being dismissed, and didn’t want to be in the ER to do what my doctor had already done, so I left.
To go or not to go to ER?
Then yesterday comes along, and the stigma in the ER situation really kicked into high gear. From the time I woke up, I was extremely dizzy. Even walking around my apartment was difficult. I checked my blood pressure a few times, and it was very high. My heart rate was also high. On one recheck of my blood pressure, it was 170/118, which is extremely high. I still didn’t really want to go back to ER after the experience I had a couple days before. Uncertain, I called the provincial Healthlink phone line and talked to a nurse, who thought I should definitely go to the ER.
I was too dizzy to get to my building’s front entrance to catch a taxi, so I called an ambulance. The paramedics showed up a short time later. When they loaded me in the ambulance, they rechecked my blood pressure. It was still high, but not dangerously so. At that point, I was freaking out that ER was going to brush me off as a psych patient again. I was upset and started crying, and told the paramedics there was no point in me going to ER. They assured me that my physical issues were concerning and they would advocate for those to be taken seriously. After several minutes of cry-fest, I decided to go ahead and go to ER; the main reason was that I didn’t think I could walk back to my apartment from the ambulance.
Presenting complaint: depression?
After waiting for a while in the waiting room with paramedics, a triage nurse directed me to a chair in the triage area to wait in. I had no further contact with ER staff until 3 hours later. At that point, tada! The psychiatric triage nurse came to talk to me. The initial triage nurse had entered into their system that my presenting complaint was depression.
I was so disgusted with this, and I wish I hadn’t had such a strong emotional reaction, because it made me less able to stand up for myself. I asked to talk to the nurse who had triaged me, who defended her decision, saying I was in ER for a mix of things and she had to pick one, so she had picked depression. She showed me the triage form she’d completed for me based on what aparamedics had said; based on that, my presenting concerns were shortness of breath, dizziness, and hypertension, and depression was part of my history. Yet when entering me into the hospital system, it was all about the depression.
I told her that had nothing to do with why I was there, but she kept insisting that yes, it did. She minimized all of my physical concerns, to the point of being really offensive. She told me that my vital signs were stable, although it had been three hours since they were last checked. Her argument that I didn’t make eye contact during the two seconds at triage when she directed me to a chair, therefore I was there because of depression, was totally absurd. I told her that this was typical of the stigma around mental illness. Her response? She didn’t have stigmatized beliefs, because she has friends with mental illness. Well that takes care of that, then, doesn’t it?!
I asked to speak to the manager. Unfortunately, it being a weekend, the next best thing was the charge nurse. Of course, the charge nurse backed the triage nurse, minimized my physical concerns, and was disgustingly patronizing. Any time I swore, she shushed me and told me not to swear because there were senior citizens around.
At that point I was just done, so I left. No marching confidently out; I was still extremely dizzy, so my walking was slow, tentative, and wobbly. But who gives a crap about that, right? I’m JUST a psych patient. Who was I to think I could escape being faced with stigma in the ER?
Trying to fight back
This hospital is part of Vancouver Coastal Health, an organization that has traumatized me before, both when I have been a patient and when I was an employee (I’m a nurse) being bullied. While they proudly claim to have processes in place for dealing with complaints, I know from experience that what they actually do is brush things under the rug rather than acknowledging and dealing with them. They steadfastly refused to admit that the workplace bullying I experienced actually happened. Their modus operandi seems to be making the whole ordeal as stressful as possible for the person making the complaint.
So, I emailed their Patient Care Quality Office to express my concerns, but I asked them not to contact me to follow up, and instead pass on to the ER manager that some anti-stigma training is called for. I also sent in a complaint about the paramedics who transported me to hospital for telling me one thing and telling the triage nurse something entirely different.
Unsurprisingly, this has set me back in terms of my depression. I’m prone to developing psychomotor retardation (a depressive symptom involving slowing of movement and thoughts) in response to overwhelming stressors. Combine that with ongoing dizziness and moving around is quite the challenge.
This kind of thing is not okay. There’s more than enough stigma to go around without health care providers hopping on board so that patients are facing stigma in the ER and other parts of the health care system. Just because someone has a mental illness does not mean that it’s always to primary issue or that their physical concerns are trivial.
There’s more on mental illness stigma on the Stop Stigma page.