I’m an experienced psychiatric nurse. I’ve heard thousands of ER stories from patients over the years. Stories about the medical clearance process before admission, treatment for medical issues ranging from minor to life-threatening, from clearly fictional to clearly real. Of course, some have been clearly fake or perhaps psychosomatic – honest mistakes are common in mental health – yet they turned out to be quite real on assessment. I teach nursing students and I train psych nurses about medical emergency management. I always emphasize a few points: In mental health practice, you see more than your share of fictional somatic complaints: lies, drama, psychosomatic issues, and so on. Motives and explanations vary, and we can only speculate much of the time. We’re not mind readers. We need to keep it in mind with every complaint. It’s also well-established that people with mental illnesses suffer rather more than their share of real medical issues. How best to proceed under such circumstances? I suggest a stepwise minimum process, the bare minimum foundation. To start, ask a few questions to perhaps clarify the complaint. Do the basics: check vital signs, 02 sat, glucose if appropriate, lung sounds, whatever fits the story you’re offered. It takes [...]![]()
