Depression: addressing our blind spots
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* Glendon R. Tait

Serious medical conditions may be missed because of the presence of a psychiatric history.1 Most of us who work at the interface of medicine and psychiatry would agree with the authors that such a consequence is not intentional.

In the system’s efforts to reduce wait times, attempts are made to find efficiencies wherever possible. This may include making assumptions based on probabilities — for example, that most chest pain is noncardiogenic and that a psychiatric history might make this even more likely.

However, the death rate for people with mental illness is about 70% higher than that for the rest of the population. As the complexity and age of patients continues to rise, we need to ensure that proper medical care is provided to everyone, including those with a history of psychiatric illness. This is very important in emergency departments with parallel process models where a patient with a psychiatric history can be initially seen by someone in psychiatry instead of the emergency physician.

Patients with psychiatric illnesses will only be assured the best of care by:

*   educating practitioners in emergency, psychiatry and other medical specialties about psychiatry and medical comorbidities

*   conducting further research to understand the attitudinal aspects inherent in various specialties, including what messages are being learned and taught as part of the hidden curriculum of medicine2

*   making ongoing efforts to continue to decrease stigma of mental illness

*   advocating for patients who cannot advocate for thier own medical care.

## References

1.  Atzema CL, Schull MJ, Tu JV. The effect of a charted history of depression on emergency department triage and outcomes in pateints with acute myocardial infarction. CMAJ 2011;183:663–9.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxODMvNi82NjMiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTgzLzcvODI2LjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

2.  Hafferty FW. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med 1998;73:403–7.
    
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