Quality Health Care Despite Stigma: How and Why

Posted by

I’m an experienced psychiatric nurse. I’ve heard thousands of ER stories from patients over the years. Stories about the medical clearance process before admission, treatment for medical issues ranging from minor to life-threatening, from clearly fictional to clearly real. Of course, some have been clearly fake or perhaps psychosomatic – honest mistakes are common in mental health – yet they turned out to be quite real on assessment.

I teach nursing students and I train psych nurses about medical emergency management. I always emphasize a few points:

  1. In mental health practice, you see more than your share of fictional somatic complaints: lies, drama, psychosomatic issues, and so on. Motives and explanations vary, and we can only speculate much of the time. We’re not mind readers. We need to keep it in mind with every complaint.
  2. It’s also well-established that people with mental illnesses suffer rather more than their share of real medical issues.
  3. How best to proceed under such circumstances? I suggest a stepwise minimum process, the bare minimum foundation. To start, ask a few questions to perhaps clarify the complaint. Do the basics: check vital signs, 02 sat, glucose if appropriate, lung sounds, whatever fits the story you’re offered. It takes perhaps two minutes to do the basics. If you uncover anything, follow it up. If not, you focus on the placebo value. It’s not just a pill, folks: placebo is everything we do to make patients feel heard, safe, cared for, important. In the end, fiction or not, you win. Compared to openly dismissing dubious complaints, you uncover some surprises, you build rapport and coöperation, and you save lots of time and energy otherwise spent on distrust and conflict. You’ll also find some medical emergencies before they become emergencies, prevent codes instead of doing codes.

I teach these things because they’re all heavily evidence-based and proven by experience and because they’re not common practice. Stigma and other forms of bias powerfully cloud judgment: that’s what such things do. And stigma is alive and well within health care: why wouldn’t it be? Providers like to think we’re all separate from patients, objective, above it all, but we’re all people, we all exist in our greater culture, saturated with stigma. Of course there’s stigma within health care, even mental health care: there’s stigma wherever there are people. We need to discuss it, not just some places but everywhere it exists, because wherever it exists, it hurts people. It’s not optional.

That all said, here’s the story that triggered this post:

A More Positive Trip to the ER

I’d love to hear your thoughts, your stories, your reactions. It’s important to me. It’s important to all of us.


  1. As someone who is actively struggling with mental illness I appreciate your honesty. It’s hard to be the person seeking treatment because you know that the stigma is alive and well, even within the walls of the hospital or doctor’s office.

    I hope that the stigma lessens and more people feel comfortable seeking treatment. I went a long time without doing anything about my issues because I was more worried about how I would be seen. Now, I just want to live.

    Liked by 1 person

    1. Thanks for your support an participation. I belive that stigma thrives on secrecy and wanes with open discussion. There are seriosu risks to taking stigma on openly as I now do, and it took me decades to reach this point. It still frightens me, but it’s also too important not to make what contribution I can. Support helps ease my mind, so thanks again – Greg

      Liked by 2 people

  2. Thank you so much for this post and for basing it on mine. It is so good to see the other side of the coin so to speak. Yes, I know that it must be hard for the ER staff to access the realities of each case. I would love to hear from other patients, staff, etc. as well sharing their thoughts and experiences.

    Liked by 1 person

    1. I meant to show how it should be done, CAN be done without much effort, honestly. There’s no excuse for bad care, none, ever. You have reasonable needs that and it’s completely reasonable to expect them to be met. That such is not typical does not reflect on you: it reflects on ERs poorly prepared to fulfill their mission. Nurse do their best without adequate resources or training: the results follow. Typical never means adequate or right, ever. Too many people make that mistake: if it’s common it’s right. Bullshit! You can and should expect better. Only when people demand better will better happen.

      Liked by 1 person

I love your comments! Please, take a moment & share.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s