Summary

‘There are different ways you can experience discrimination including: direct discrimination: if you’re treated worse than others because of your mental health problem and indirect discrimination: if a person or organisation has arrangements in place that put you at an unfair disadvantage. Mental Health Discrimination also includes if you’re harassed, intimidated, or humiliated.[1]

In A Psychiatrist in Fife #1, I recount an incident that occurred with a psychiatrist in Scotland, who had never met me, who wrote a letter about me, saying that I have Factitious disorder and that my facial pain is ‘made up to fill a need to be sick.’ As a result of this letter, I was unable to get medical treatment for a physical condition. In this post, I discuss an incident of both direct and indirect mental health discrimination, that I faced as a result of this letter, which further delayed my ability to get a diagnosis and medical treatment for my facial pain.

Mental illness related stigma within the healthcare system, creates serious barriers to access and quality care. [2]

How It Happened

The Ear Nose and Throat consultant in Fife, who informed me about the psychiatrist’s letter, referred me to a Tertiary Head and Neck Centre, because an MRI scan had shown abnormal masseter muscle. However, he included the psychiatrists’ letter with his referral. The next surgeon told me, that he thought the psychiatrist should not have written the letter, without meeting me, and he agreed to do an MRI Neck and CT Neck scan. He told me that, after the scans, he would get me back to ‘find a way forward.’

In On Good Medical Practice #2, I discuss the ways in which one of the surgeons who I consulted with, deviated from Good Medical Practice. It was this surgeon. I never heard from him again after the initial consultation. He sent me for the scans, but he did not offer me a follow up consultation to discuss the results. I wrote to him four times asking for a follow up consultation, but he ignored my letters. I was stonewalled by him for eighteen weeks.

Closed Case

My left ear pain was intensifying. I had a feeling of fullness and violent Pulsatile Tinnitus in my left ear. I explained this to him in written correspondences, but he continued to rebuff me. The surgeon closed my case. I later discovered that it was mental health discrimination, that seemingly lay behind his silent treatment of me.

My Discovery

I wrote to the NHS Trust and requested copies of my MRI and CT scans. Two CD disks and two radiology reports arrived. When I studied the contents, my disbelief was hard to contain. I was stunned to see in the CT Neck and CT Bone scans such a stark asymmetry between the two sides of my face. There were also large dense white areas, where I experience the pain. I was unable to ask the surgeon any questions, due to him ghosting me. More startling, however, was seeing in the report, what the surgeon had said about me to the radiologist. He wrote;

Be Careful with this one. Patient has significant psychiatric problems but also chronic pain from parotid disease. Also, previous story of orbital cellulitis and pain across the head.

This surgeon had met me once, for 30 minutes. He took that information from a letter written by a psychiatrist, who had never met me, which the surgeon himself, had said was wrong. This was beyond shocking. This was a Head and Neck scan being requested for physical pain. It was therefore grossly inappropriate to a) remark about my mental health and b) present inaccurate information and opinion as fact. The surgeon’s remark clearly influenced the radiologist, who seems to have not been transparent, in his reading of these radiology images.

The Reality

The radiology images below, are from the scans that this surgeon requested. Dear reader; I have left sided facial pain. Does the asymmetry between the two sides of my face look like a physical or a psychiatric problem?

I do not have ‘significant psychiatric problems.’ My current episode of acute distress, and yes, protracted crisis, is related to enduring severe physical pain for now eleven years, and not being shown an ounce of respect by over fifty medical consultants. It would take its toll on anyone. The picture of the man’s face below. That is how I feel inside. It’s not a psychiatric problem. It’s a human who has been kicked hard by the system and who is well and truly beat.

Even if a patient does have ‘serious psychiatric problems,’ this comment has no place on a radiology request form for a CT Neck scan, which is investigating parotid disease. No place at all. The surgeon’s discriminatory remark is now on my Scottish medical records. If a radiologist from another NHS Trust requests these scans, they will see it. A new radiologist has already requested those scans from Scotland, and I am certain that he has seen the surgeon’s comment. This recent radiologist has admitted to finding abnormality in my recent MRI scan, but no follow up, or treatment has been offered. They have closed my case again.

Diagnostic and treatment overshadowing, whereby physical symptoms are misattributed to a patient’s mental illness, creates delays in diagnoses and treatment options.^29’ [3]

Good Medical Practice

Domain 2- Patients, Partnership and Communication

‘The approach and attitude of a medical professional can have a lasting impact on a patient. Treating patients with kindness, compassion and respect can profoundly shape their experience.’

Treating Patients Fairly and Respecting their Rights

19) You must treat patients fairly. You must not discriminate against them or allow your personal views to affect the treatment that you provide.

Sharing Information with Patients

29) You must listen to Patients and encourage an open dialogue about their health and respond honestly to their questions.

Domain 4- Trust and Professionalism

Communicating as a Medical Professional

All Professional Communication

89) You must make sure any information you communicate as a medical professional is accurate, not false or misleading. This means;

a) You must take reasonable steps to check the information is correct.

d) You must not present opinion as established fact.[4]

Ignoring me for eighteen weeks, not answering my questions, and writing a misleading and inaccurate comment about me to another medical professional, in which he presented his ‘opinion as fact,’ (89 d) is not following guidance. This surgeon discriminated against me in a vulgar way. This is not ‘treating a patient fairly,’ (Good Medical Practice,19.)

As I said in  Good Medical Practice #3, My Facial Pain is a quest to find a diagnosis and medical treatment for my condition. It is also a quest to understand how such poor conduct by medical professionals has gone unregulated for this long. Why has no one intercepted this bad practice? It is a disgrace. There needs to be much stricter regulation of all doctors in the UK.

‘The combination of high rates of physical illness and low rates of receiving effective treatment leads to fatal consequences of discrimination and neglect.’[5]

Systemic Discrimination

I have always supported anti-discrimination movements, particularly anti-sexism and discrimination against people of other races, but until you actually experience discrimination for yourself, it is not possible to understand how widespread and enduring its effects are. A lady on X, (formally Twitter) recently replied to one of my tweets about institutional bullying. I get this… she said. Institutional bullying has an entrenched power far beyond that of individuals.

That applies to systemic discrimination, too. The ‘note’ that the Head and Neck surgeon wrote to the radiologist, saying that I have ‘significant psychiatric problems,’ was yes, written by the surgeon, but it was not his voice in isolation. It was the NHS Trusts’ voice too. That opinion has the power to spread from that NHS Trust to another. It then develops into an all-pervasive belief about you, which becomes entrenched within the system. It’s petrifying. I felt backed into a corner with no where to turn.

I felt unable to speak for fear of saying something that would compound this discriminatory view of me.

Qualitative research has found that for many healthcare providers, it is only through the experience of receiving anti-stigma training that they become aware of the subtle and unintended ways certain beliefs and behaviours may have been contributing to stigmatizing experiences among their patients. (Knaak et al.14 see also Sukhera et al.25 and Horsfall et al.28) [6]

Foot Notes

[1] The Mental Health Foundation. Stigma and Discrimination, www.mentalhealth.org.uk

Stigma and discrimination | Mental Health Foundation

[2] Knaak S, Mantler E, Szeto A; Mental Illness-Related Stigma in Healthcare, Healthcare Management Forum, March, 2017.

[3] Knaak S, Mantler E, Szeto A; Mental Illness-Related Stigma in Healthcare, Healthcare Management Forum, March, 2017.

[4] The General Medical Council; Good Medical Practice 2024, published August 2023. This revised edition of Good Medical Practice will come into effect on January 30, 2024

[5] Thornicroft G, Rose D, Mehta N; Discrimination Against People with Mental Illness: What Can Psychiatrists Do? Cambridge University Press, January, 2018. Copyright © The Royal College of Psychiatrists, 2010.

[6] Knaak S, Mantler E, Szeto A; Mental Illness-Related Stigma in Healthcare, Healthcare Management Forum, March, 2017.