The difficulties of trying to be proactive

[JonathanClouse]

So my mental health symptoms have been increasing for about the past week, and so after talking it over with my therapist, we agreed that I would try to get an emergency appointment with my outpatient Psychiatrist. But when the nurse triaged me, she told me to go to the Emergency Room...that the only person who could alter my medications was my doctor, and that he was out of the office that day and was booked solid for the next week (the front desk only found an opening on June 20th). So not being suicidal or homicidal, I went to see if my family doctor might be willing to help. But being that my psychiatric history is so complex, she did not feel comfortable in doing anything. So I ended up going to a local Emergency Room where the Social Worker asks me what I expected THEM to do differently for me. Finally, the E.R. Physician allowed me to stay overnight and talk to a Psychiatrist the next morning. So I did, and the Psychiatrist agreed to increase my anti - anxiety medication from a half tablet twice a day to a full tablet twice a day. But she wrote the wrong dosages on the discharge paperwork, and didn't provide me with a new script before I was discharged. So when my home health nurse looked at the paperwork, she stated that she could not give me a full tablet twice a day until the dosages were corrected. And so I went back to the ED, and explained my situation, and was told that the only way they could correct the orders was for me to check in AGAIN! But I, not wanting to bother them attempted to find a way to scrape by until I could get things straightened out on Monday at the mental health center. But I couldn't get a refill of the ORIGINAL prescription, and I couldn't get any urgent care clinics to issue a new prescription. So I went back to the ER, re-explained my situation, and ended up checking back in to get a corrected order. The frustrating part is that while the staff treated me okay when face-to-face, I could overhear them talking about my visit among themselves. I could tell that they were frustrated with me being there, but...I don't know...trying to be proactive and having to go through this extended process, and then being seen as one taking advantage of the ER to resolve everything? So frustrating.

[meanmaryjean, DNP, RN]

OP: You probably shouldn't be posting your personal medical conditions under your real name- if that's what your screen name is.

[FolksBtrippin, BSN, RN]

I'm so sorry you went through all of this. Mental health care is broken.

There are people trying to fix it.

I like that you are advocating for yourself. Hang in there.

[Mandychelle79, ASN, RN]

I'm sorry you experienced that. I used to think it was only mental health that was broken but after just 5 months of med surg I guess it's across the boards. Pts admitted because PCP can't get them in in a reasonable amount of time. It's frustrating.

[Meriwhen, ASN, BSN, MSN, RN]

It's a lose/lose situation: cutbacks means there's less outpatient providers and services, so delays in getting outpatient service increase. So when patients can't get services, they go to the ED. But the ED isn't equipped for medical management of psych patients, and a lot of ED providers won't make medication changes or prescribe anything new, except maybe a short-term medication (as in a week or so). And then there's not enough psych beds in the hospitals, so a lot of psych patients are stuck waiting in the ED for an extended period of time, especially if they are Medicaid patients or lack insurance.

What doesn't help is that there are those patients who abuse the system. They'll make frequent visits to the ED in the hope of getting their desired meds (usually benzos or opiates), want attention, because they don't like their current living situation and want the ED to find them a new one, or just because they want 3 hots and a cot for a couple of days. So those who do have a bonafide need for services are often met with a jaded, less-than-understading attitude.

[debiklages, MSN, RN]

Hi it sounds as though you have been caught up in a health care system that is seriously stretched. I hope that you are able to work through your health care issues and get the help that you need. In the interim it seems as though an integrated non pharmaceutical treatment plan might assist. You probably are doing this already but just mentioning it in case this is not the case. Get well soon.