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Emergency department staff views and experiences on diagnostic overshadowing related to people with mental illness

Published online by Cambridge University Press:  17 October 2012

A. van Nieuwenhuizen ,
C. Henderson ,
A. Kassam ,
T. Graham ,
J. Murray ,
L. M. Howard  and
G. Thornicroft
A. van Nieuwenhuizen
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
C. Henderson*
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
A. Kassam
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
T. Graham
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
J. Murray
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
L. M. Howard
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
G. Thornicroft
Affiliation:
Health Service and Population Research Department, King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: Claire Henderson, Health Service and Population Research Department P029, King's College London, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK (Email: Claire.1.Henderson@kcl.ac.uk)
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Abstract

Aims.

To investigate recognition of diagnostic overshadowing, i.e., misattribution of physical symptoms to mental illness, among emergency medicine professionals; further, to identify contributory and mitigating factors to diagnostic overshadowing.

Methods.

In-depth individual interviews of 25 emergency department clinicians and qualitative analysis using thematic analysis.

Results.

Diagnostic overshadowing was described as a significant issue. Contributing factors included: (1) problems of knowledge and information gathering; (2) clinicians' attitudes toward people with mental illness, substance misuse and frequent attenders; and (3) difficulties in working with mental health services in the context of a 4-h target for discharge from the emergency department. Avoidance of patients with a psychiatric diagnosis was also described, due to fear of violence.

Conclusion.

The physical health care of people with mental illness in emergency departments may be adversely affected by diagnostic overshadowing and avoidance by clinical staff, along with difficulties created by the illness, medication and the emergency department environment. Greater joint working between psychiatric and emergency department staff is suggested as one way to reduce diagnostic overshadowing.

Keywords

Diagnostic overshadowingemergency departmentmental illness stigmamedical clearance
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 22 , Issue 3 , September 2013 , pp. 255 - 262
Copyright
Copyright © Cambridge University Press 2012 

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