Emergency room staff face constant pressure to work both quickly and efficiently. While a doctor is working on one patient, another could have come in with severe
asthma, a burst appendix or worse.
Unfortunately, staff time with individual patients in the ER is limited, which could lead to bedside manner seeming abrupt.
The stress hospital staff feel is met with patients’ stress, as a visit to the ER is never enjoyable. A patient may be in pain, psychotic, bleeding and/or just plain exhausted, not to mention that they might have been in the waiting room for hours.
Under such circumstances, a patient might see a doctor’s tone as harsh, even if such a tone wasn’t intended. Stress can lead to heightened sensitivities by both the doctor and the patient.
Emergency exam rooms are not spaces for exchanging pleasantries.
Doctors who work in the ER are generalists. They have to know a little about a lot. If specialized knowledge is required, they refer to specialists, which is why Cold Lake patients may be sent to Edmonton if their condition is beyond the scope of what a local doctor can provide.
Psychiatric patients, if their lives aren’t in immediate danger, get referred to Cold Lake’s Mental Health Services, which is open during regular business hours, Monday to Friday.
If the patient comes into the ER outside those hours, he or she is going to have to wait.
Anyone who has ever had a mental health crisis knows how miserable it can be, especially when help is delayed.
In a perfect system, where resources are limitless, Cold Lake would have a 24/7 acute psychiatric care team made up of psychologists, psychiatric nurses and social workers with a direct line to a psychiatrist.
If a patient came into the ER at 2 a.m. with suicidal ideation, but with no real plans to kill his or her self, a doctor could refer the patient to the acute care team for immediate further help.
Detailed mental health assessments can take up to an hour, which is far beyond the amount of time an ER doctor has to spend with a patient.
The reality is that the system in Cold Lake is not perfect.
A doctor, working in an under resourced hospital, must discharge the patient when deemed safe to do so and refer them to Mental Health Services.
In the ER, it’s not that physical medical problems automatically trump mental health conditions, but in an emergency setting, if there is no immediate threat to life and the patient can be managed in the community, then the emergency bed they occupy must be made available to other urgent cases coming in.
Sometimes an ER doctor doesn’t even have time for sensitivity or empathy.
That is the reality of emergency services.
Again, an acute psychiatric care team would be the solution. But how would it be funded and how would enough staff be recruited to operate it?
Being able to provide adequate mental health services to Cold Lake residents is a very multifaceted problem.
Cold Lake’s challenges are not unique.
Even larger Canadian centres find their medical facilities under staffed and under funded.
It should be a psychiatrist tweaking a person’s psychiatric medications because such a specialist knows those medications in and out.
Having a psychiatrist double check a nurse practitioner’s or general physician’s prescription is important.
However, even in cities like Winnipeg, a patient can wait up to a year or more to see a psychiatrist, and so general physicians and nurse practitioners are left to do their best in the meantime.
When an ER doctor doesn’t have the time to spend with patients, regardless of bedside manner, which is subjective anyway, a clinically depressed patient may very well feel defeated like Andrea Head-Lahey did when she sought help in the ER over the Labour Day weekend.
A patient might feel the doctor, lacking in time and having to be dismissive, did the equivalent of putting a gun in the patient’s hand and saying “do what you have to do,” like Head-Lahey said, because the doctor is not able to provide the patient with the immediate help that is being sought.
Such feelings are not the fault of the doctor who is only part of a larger system that is failing mental health patients in Cold Lake.
Head-Lahey’s words are sharp and they certainly may sting those who work in the mental health field. It must be particularly difficult for the doctor who treated Head-Lahey that day to hear that she felt he failed her.
People become doctors to help patients. So, it is likely disheartening when the system medical professionals work in don’t always allow them to do that well because of the lack of resources.
The story about Head-Lahey’s experience, and her feelings around it, is important.
Stories like these should be a wake up call to those who have the power to fix the system. People are hurting and providing adequate mental health access needs to be moved up the priority list of government officials and other policy makers.
When medical professionals on the front line hear stories like Head-Lahey , maybe it will inspire them to think of ways they can improve their patient care, as everyone always has room for improvement.
A doctor’s tone, body language and word choice may impact a patient’s ER experience. And, when a doctor feels his or her mind is 20 places at once, that is the time to remember to focus on the patient he
or she has before them. Really listening goes along way for mental health patients. Sometimes all a patient is looking for is reassurance.
Addressing mental health care access is a complex problem.
In the meantime, as Head-Lahey said, those who have mental illnesses should not be discouraged if an ER doctor doesn’t have adequate time for them. It shouldn’t stop them from reaching out to other resources, like the 811 Health Link number or another ER if necessary.
Eventually a patient will get to the top of a waiting list to see a psychologist or social worker in Cold Lake.
Help is out there, but until a mental health patient is able to access it and begin to manage his or her illness, life can be anguishing.