As someone who has lived with depression all my life, I’ve experienced a form of discrimination that makes it hard for me to get good medical care. Clinically, it’s called diagnostic overshadowing - and is defined as a process where health professionals wrongly presume that present physical symptoms are a consequence of their patient’s mental illness. As a result, the patient with mental illness gets inadequate diagnosis or treatment[i].
Casually speaking, I call it lazy medicine. As a healthcare professional myself, I can walk the diagnostic walk and talk the treatment talk - so, it can be easier for me to confront diagnostic overshadowing when it happens. I’ll generally start with, “What tests would you suggest if you weren’t dealing with a patient who had depression?” to address the mental illness bias coming from my doctor. Sometimes that helps to broaden the physician’s diagnostic outlook, minimizing the shadow of my mental illness in the treatment plan. When that works, I can feel good that my medical concerns are being addressed properly.
However, sometimes I can’t shake the diagnostic overshadowing going on. I tell the health professional that I’m frustrated by his or her lack of time or inclination to think beyond my depression diagnosis. Sometimes there’s finger wagging or I'll launch into a teachable moment soap-box lecture. Other times I don’t even bother to address the obvious bias. I just go elsewhere to find better care. And, sadly, it happens often. I’ve learned that sometimes a general physical issue can turn into a medical odyssey of sorts, where it takes months or years (yes, years) not days or weeks for diagnosis or treatment to finally occur.
Research indicates that children and adults with mental illness typically receive poorer health care than the general public[ii]. Studies also state that those who live with mental illness often report negative attitudes from their physicians, which prevents them from seeking further healthcare intervention[iii]. As a result, people with mental illness suffer higher rates of physical illness and undiagnosed disorders - and are more likely to die prematurely than members of the general population[iv].
Tips to Help with Diagnostic Overshadowing
When you find your medical symptoms marginalized or dismissed by your healthcare professional as a result of your mental health diagnosis, try the following:
[i] Jones, S.; Howard, L. & Thornicroft G. (2008). Diagnostic overshadowing: Worse physical health care for people with mental illness. Acta Psychiatric Scandinavica, 118: 169-171.
[ii] Walker, E.; McGee, R.E. & Druss, B.G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry, 72(4): 334-341.
[iii] Thornicroft, G. et. al. (2007). Discrimination in health care against people with mental illness. International Review of Psychiatry, 19(2): 113-122.
[iv] Jorm, A.F. & Reavley, N.J. (2013). Depression and stigma: From attitudes to discrimination. The Lancet, 381(9860): 10–11.