Physical health care
Chambers Mary in Psychiatric and mental health nursing, 2017
Chadwick et al.46 undertook a review of studies from the last decade from the service user perspective in relation to physical health. Studies revealed issues around inaccessibility of physical health care and a mistrust of services, including practical difficulties such as long waiting times, hurried appointments and crowded waiting areas. Service users felt that professionals lacked information, education and knowledge of illness and treatment options. They reported poor physical assessments and experienced diagnostic overshadowing, which led to service users not disclosing concerns. Diagnostic overshadowing is when symptoms of physical illness are attributed to someone’s mental illness and thus dismissed by health care professionals.
Unconscious bias
Anna-leila Williams in Integrating Health Humanities, Social Science, and Clinical Care, 2018
Diagnostic overshadowing means the mental illness diagnosis eclipses the health professional’s ability to identify other potential diagnoses – or as Abraham Maslow (1966, p. 15) writes, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail.” Diagnostic overshadowing can lead to dire oversights and health consequences when we incorrectly presume the patient’s signs and symptoms relate to their mental illness and neglect to conduct a work up for a physical illness diagnosis (Thornicroft, 2006). Epidemiologic data repeatedly demonstrate excess morbidity and mortality for people with mental illness as compared to the general population (Kisely, Sadek, MacKenzie, Lawrence, & Campbell, 2008; Laursen, Munk-Olsen, & Gasse, 2011; Laursen, Nordentoft, & Mortensen, 2014). People with mental illness have up to seven times higher mortality rate as compared to the general population (Laursen, Munk-Olsen, Nordentoft, & Mortensen, 2007). Unfortunately, research has not yet exposed the degree to which diagnostic overshadowing contributes to the increased burden of disease and premature death experienced by people with mental illness. As I said earlier in this chapter, while we wait for evidence to accrue, we can commit to do better by our patients.
Aging and Intellectual/Developmental Disabilities
K. Rao Poduri in Geriatric Rehabilitation, 2017
This makes it essential that differential diagnosis is conducted to rule out and treat all causes for decline or behavioral changes. It is important that an assumption of loss and disability is not an automatic conclusion as this then increases the risk for diagnostic overshadowing.20,24 Diagnostic overshadowing occurs when the preexisting disability is blamed for the decline or behavioral changes rather than looking for other underlying causes unrelated to the disability or existing diagnosis. The tendency for diagnostic overshadowing, even if the practitioner is not aware of this tendency, cannot be overlooked, making it essential to communicate with the advocates and the adult with disability to determine the baseline functioning and behavior.1,7
Age of Autism Spectrum Disorder Diagnosis and Comorbidity in Children and Adolescents with Autism Spectrum Disorder
Published in Developmental Neurorehabilitation, 2022
Geraldine Leader, Amy Hogan, June L. Chen, Leanne Maher, Katie Naughton, Nathan O’Rourke, Mia Casburn, Arlene Mannion
Results from this study found a relationship between the presence of a medical or psychological comorbid condition and the age at which the participant was diagnosed with ASD. On average, children with a medical or psychological comorbid condition were being diagnosed thirteen months later than children without a medical or psychological comorbid condition. Consistent with previous research,22 this finding indicates that participants received a later diagnosis of ASD if they presented with a medical or psychological comorbid condition, which in turn can affect the provision of receiving early intervention. Diagnostic overshadowing bias can occur where clinicians focus on the presence and symptoms of one condition, and not another condition. A greater awareness of the co-occurrence of other conditions with ASD is vital in order for children to receive a correct diagnosis. It is also important that children receive the treatment needed for the comorbid conditions that they present with.
Barriers and Possible Solutions to Providing Physical Health Care in Mental Health Care: A Qualitative Study of Danish Key Informants’ Perspectives
Published in Issues in Mental Health Nursing, 2021
Birgitte Lerbæk, Andrea McCloughen, Marlene Briciet Lauritsen, Jørgen Aagaard, Julie Nordgaard, Rikke Jørgensen
Several factors related to structures in health care systems have implications for the provision of physical health care to people with SMI. Inequalities related to allocation of resources in the healthcare sector, and the organisation of healthcare services are described as barriers contributing to people with SMI having poorer access to treatment of physical illness (De Hert et al., 2010; Laursen et al., 2009; Nordentoft et al., 2015). Diagnostic overshadowing is a problematic phenomenon within health care systems internationally, which contributes to delay in the detection of physical illness and in treatment of physical health conditions among those with SMI. Diagnostic overshadowing occurs when MHCPs overlook physical symptoms experienced by people with SMI by wrongfully interpreting them as related to symptoms of mental illness (Jones et al., 2008; McNamee et al., 2013; Nash, 2013). Such practices are described as a characteristic of the stigma within the health care system, that is reinforced by negative attitudes among MHCPs (Jones et al., 2008; Nash, 2013).
Barriers to Healthcare for Persons with Autism: A Systematic Review of the Literature and Development of A Taxonomy
Published in Developmental Neurorehabilitation, 2020
Chloe Walsh, Sinéad Lydon, Emily O’Dowd, Paul O’Connor
Caregivers/persons with autism feeling that their concerns and expertise were being ignored by HCPs, and that they were, consequently, not being treated as partners in care is also consistent with the extant autism literature.96 Engaging in shared decision-making has been shown to be significantly associated with improved satisfaction with the child’s overall primary healthcare for parents of children with autism and also with improved guidance regarding controversial treatments.97 However, when compared to children with Down’s Syndrome or Cerebral Palsy, children with autism were less likely to receive a shared decision-making approach to care.98 More collaborative healthcare provision and planning, which involves the caregiver and/or patient, could also potentially reduce the occurrence of diagnostic overshadowing (i.e., the misinterpretation of symptoms as being related to an existing condition rather than being signs of an undiagnosed medical issue).99 Diagnostic overshadowing is commonly reported by persons with autism and other developmental disabilitiese.g.84,100 and may be the result of HCPs having difficulties in interpreting symptoms in their patients with autism.63 Caregivers are likely better equipped to provide important information regarding new/unusual behaviors that may signal a physical health issue, particularly when it is difficult for the patient to articulate their pain/symptoms.100
Related Knowledge Centers
- Autism Spectrum
- Comorbidity
- Developmental Disability
- Intellectual Disability
- Mental Disorder
- Diagnostic Delay