Hurried Psychiatric Labelling: A Preventable Medical Error in an Emergency Department

Because societies today are industrialized, physical and psychiatric problems have increased significantly. Simple medical approaches are no longer sufficient for managing patients. This is quite obvious in an overcrowded emergency department. Moral and legal aspects of patient management should also be considered. Emergency management is like a double-edged sword. Physicians encounter both somatic and psychiatric presentations simultaneously. In such situations, decision-making can be difficult.1,2 Immediately marking a patient as a histrionic or conversion case is a wrong approach that is currently seen in some emergency departments. Recent forensic medicine cases have explained some clues; life-threatening conditions that had not been given much attention by the physician; some were even considered as psychiatric cases. This is more important when an organic problem is hiding behind a psychiatric presentation (pseudo-psychiatric emergencies) and could easily be ignored or even mismanaged. Overcrowding and full-stress situations are the two main factors leading to labeling errors. Normal adaptive responses to stress are due to the sympathetic nervous system, adrenal or cortisol response; an abnormal or improper psychiatric response may indicate organic problems rather than a purely psychiatric disorder.3 Sometimes, the conversion disorder may present immediately after a medical procedure such as surgery; hence, it is necessary to rule out critical complications rather than tagging the patient initially as a psychiatric case