The High Cost of Psychiatric Misdiagnoses

A relatively recent European study documented the high cost of psychiatric misdiagnoses in emergency departments (EDs). What it found: misdiagnosed panic attacks were costing hospitals a small fortune.

Because they’re not psychiatric specialists, ED physicians often were baffled by patients’ symptoms, unable to tell if they were having bad reactions to illicit drugs or having a problem requiring immediate psychiatric intervention. In many cases, on-call cardiologists and endocrinologists were summoned—and both time and money were lost.

The problem is arguably even worse in the U.S., where most psychiatric practices haven’t implemented electronic health record (EHR) systems. Remember that meaningful use incentives weren’t extended to behavioral healthcare in the original HITECH legislation; as a result, psychiatry lacks some of the financial incentive driving other specialties toward EHRs. Since there’s very little interoperability between most hospitals and nearby psychiatric practices, the case for telepsychiatry is a compelling one.

In the case of panic attacks, for instance, hospitals can waste precious hours and countless resources investigating a patient’s cardiac and glandular health. A wide cross-section of people experience these attacks, including celebrities like Johnny Depp, Barbra Streisand, and football Hall of Famer Earl Campbell. Yet most EDs don’t have rapid access to highly trained, board-certified psychiatrists who can quickly identify mental problems masquerading as physical ones.

For example, depression often appears to present as a sleep disorder—which means an ED patient could be sent home with medications that can deepen depression. With a telepsychiatrist as the ED’s first line of defense, these kinds of critical misdiagnoses can be prevented.

There are other advantages to on-call telepsychiatry as well. Beyond panic attacks and depression, an ED is often required to handle a myriad of psychiatric evaluations to address suicide attempts, substance abuse, physical abuse, mental illness, and psychiatric medication issues. Further complicating an ED’s ability to treat patients are the complexities of state psychiatric systems—often something in which an ED physician is not fully versed. A highly qualified telepsychiatrist can ensure complete compliance with state mental health regulations. Rapid response time is another huge plus. Many communities have a shortage of psychiatrists, especially those willing to be on-call throughout the night.

This can be especially problematic when a patient has been placed on a psychiatric hold. Without the proper assessment from a psychiatrist, the patient must remain in the hospital, but often times given the proper medical attention it becomes evident that the patient can be released early. The hospital can then free up a bed space and lessen overcrowding in the ED.

Sigmund Freud had a lifelong struggle with panic attacks. It’s fitting that the profession he launched can now accurately pinpoint the condition far better than most generalists in today’s emergency departments. And in the case of telepsychiatrists, far faster, too.