grrr..

sometimes, i'm flat-out appalled at the lack of compassion that i see in my profession. i guess in medicine, you kinda see the worst and best sides of people. as patients, and as medical professionals.

i had a neuro consult yesterday for some gentleman in the ED with "seizures". long story short, they weren't epileptic or "real" seizures- they were pseudoseizures. but for the patient, they were no less debilitating than the real thing. he was super depressed (and i mean CLINICALLY, by the friggin DSM-IV criteria depressed), and angry at the nurses and residents who were disregarding nearly everything he said because they believed he was "faking it". my senior resident was curt and abrupt with him, mainly because she had been told beforehand by the ER resident that the consult was more of a legal formality than anything else (i.e. she was totally biased against believing anything the patient said). one of the nurses, to whom i tried to explain the concept of pseudoseizures as a somatoform disorder- basically that he WASN'T doing it on purpose, said something like, "you know, he should be admitted just so he can sit around for 30 days in the hospital. we should do something PAINFUL to him." the ER resident made a comment to the effect of, "next time i want a break from my wife, i think i'll have a seizure." i was sooo... sooooooo.... sad. and pissed. i've starting thinking of these "psych" patients as my own personal outreach population.... these are exactly the kinds of people i want to treat, because NOONE else seems to understand them or want anything to do with them. i spent a good 15-20 minutes trying to explain to the patient that noone was going to do anything for him at that time, and that he really needed to see a psychiatrist; i took the time because i knew noone else would.

part of my self-righteous anger came from the admittedly unjustified arrogance i carry around with me as someone interested in psychiatry. i have seen malingerers. and this patient really, really did not strike me as someone who was malingering. so how crappy would it be to be in pain, having these seizures twice a day, and to be completely ignored or marginalized when you try to get help? how infuriating would it be if this was a loved one? it frustrates the heck outta me when people dismiss a psychiatric/somatization issue as "not real".

i truly believe that the mentally ill are among the most underserved populations. they walk our streets as homeless vagrants, and clog up our ERs because they don't have anywhere else to go. to me, these people are "the least of these, my brethren."