Human Error in Diagnosing Mental Illness
Injuries are ubiquitous, tied seemingly into the fabric of everyday life. Be it a stubbed toe walking initially into the entryway after a day of schooling or work, cutting a finger while cutting carrots for dinner or in worse cases breaking a wrist after slipping on a patch of ice. Accidents happen and thankfully a simple visit to the doctor can generally fix issue through either antibiotics, steroids or splint or a combination. A few weeks later, a bit of rest and the injury is healed almost as if it never happened. It’s a straightforward process in nearly all cases except those involving mental health. The cause isn’t nearly as exact, not being one specific event but possibly multiple over years. Figuring out the problem, whether it’s a cut finger or broken wrist-depression or PTSD is an entirely differently affair in itself, an affair that many in the psychiatric field are having a startlingly difficult time in solving which in turn is putting millions of people at an even greater risk. Why are trained professionals allowing for so much error? As complex as the illnesses themselves the answer is composed of a number of variables. First, one must visit the doctor.
What one person believes to be just a bad stomach ache, with a visit to the local Urgent Care could actually be a symptom far more serious which could require immediate attention. A person only finds this out if they actually make it to the office ergo if that same person never goes then they never know. Unfortunately, as simple as this is, it is incredibly common. A survey from 2000 showed that 25% of people haven’t seen a medical professional of any kind in the past year (Schmitz, Norbert, and Kruse 382). The percentage does not discern between socioeconomic status which plays a large impact, generally the wealthy have the money and time to be healthier to actually see a physician on a regular basis 57% of high class see a doctor regularly compared to lower class at 18.2% (Schmitz et al. 382). The notable thing to take away from those numbers is that lower class people are far more likely to have a mental illness than their richer counterpart. So a person actually get’s to the doctor a big step in the prevention of misdiagnosis is already gone now actually in front of the doctor is where most of the mishaps happen.
It is imperative that patients trust the doctor they’re seeing, to believe that the doctor has their best interests at heart and will be guiding them from disability to full recovery. That’s what they do, people get injured, they see the doctor and the doctor tells them how it can be fixed. It’s a scary thought to think then, that a person with severe depression sees a psychologist hoping to get some medication or be referred to a therapist to help relieve the issue and get back to being a functional person but walks out of the building being told that it’s mild neurosis probably caused by the colder weather, to just wear a sweater and all will be well. The sum of such an event can be truly heart breaking and yet this is actually a common phenomenon-the intentional misdiagnosis of patients. Managed Care Organizations, also known as MCOs were born out of the idea that healthcare should be cheaper, better streamlined for the modern age and monitored more effectively. In order to do this they became a bridge for medical providers, the consumers (the patients) and the payers (insurance companies or out of pocket). They also began to set the standards and definitions of care, how much each treatment should be etc. Seemingly a good addition to a confusing system of healthcare, it faltered greatly while 42% of counselors were at least somewhat satisfied (6% being indifferent) an even larger amount at 47% were entirely disatisfied ( Braun and Cox 426). In setting the definitions for what qualifies as a mental illness, for what’s covered under specific insurances they created an enormous confusing system which created many gaps in coverage and definition. This meant that a person’s insurance might cover only a few select mental illnesses forcing them to pay out of pocket for others, in which case depression might not be covered but PTSD would be. This put a huge moral and even legal issue on the shoulders of medical professionals. A person suffering with depression, whose insurance covers PTSD would be told that they actually, have PTSD simply so they could get some kind of care. Doctors being under a strict confidentiality code could not tell the patient that their insurance doesn’t cover their disease and would simply not be able to tell them the truth. So it becomes either to issue no confirmed diagnosis or misdiagnosing purposely in hopes that the patient can get some sort of help that will alleviate some of the issue. These diagnoses have a massive impact on the medical industry in 1995 and 1996 creating a loss of $100 billion (Braun and Cox 429). However, even a person with great insurance can still suffer.
For many people, it’s easier to talk to someone they’re familiar with. A friend, uncle, dog, or even someone of the same skin color. Misdiagnosis isn’t always the problem of the doctor, they can only diagnose with what they know and what they know can only come from one place-the patient. Tests can only reveal so much if the patient is willing to take them honestly, to talk to them honestly. It turns out many races of people only feel comfortable in talking about the deeply personal topic of mental health with other people of their own race. The speculation for this is that in order to open up and talk about often hugely uncomfortable things people need to feel like the person that’s listening can understand or relate in some way. There are also many topics like drug abuse or sexual orientation that are especially sensitive in certain cultures and others that are more prevalent (for example racism). An African-American it’s been shown will open up more so and stay in therapy longer if the psychiatrist is also African-American and so on with Asians, Native Americans (Ibraki and Hall 944). An African-American speaking to a white doctor is likely to not talk as much if they’re suffering depression based around continued racism at work or PTSD from an abusive mother.
There are many causes of misdiagnosis unfortunately in the case of MCOs the medical industry is actually encouraging them, in others it’s a matter of simply better understanding the problem. It’s a troubling thought that so many people in need of treatment either aren’t getting it or are being completely misguided, it’s as much a societal as it is a medical problem and one that needs immediate attention.