Guilty as Sin


Does it surprise you to know that we are guilty as sin when it comes to limiting access to psychiatric care?  I don’t mean ‘we’ as in an industry but ‘we’ as in The Coders; the people who watch over your ICD-9 coding and OASIS assessments,

It is fairly common for one or more us to refer to someone who has made us angry as:

    • crazy
    • bonkers
    • nuts
    • nusto fruitso
    • psycho
    • shizo
    • nuttier than a fruitcake
    • unbalanced
    • a sicko
    • wigged out

There are more creative ways to call attention to someone’s state of mind that we use mostly in attempt to be humorous.

    • He just ain’t right.
    • Her driveway doesn’t go all the way to the road
    • He’s a little left of center
    • She’s knitting with one needle
    • She’s a sandwich short of a picnic
    • And my favorite as read in a clinical record written by a local physician held in very high esteem in the community, ‘her elevator doesn’t go all the way up to the top’.

We call addicts crackheads and junkies even though statistically speaking most people have a close friend or family member addicted to one or more drugs.  We recite the nursing school line that addiction is a disease but we treat those affected as though they are human waste.

So, what’s the big deal?  Consider that most people suffering serious mental illness have some connection to the real world.  They hear insult after insult thrown about in normal communication describing their symptoms.  The know that being nuttier than a fruitcake is not a common aspiration and that the elevator ideally reaches the top floor.  No young girl wants to grow up and be a crack whore and no young man dreams of possibly being able to hold a minimum wage if his meds are just right.

The average person with schizophrenia is diagnosed in his or her early 20’s.  They know that telling someone that the CIA is onto them will result in ridicule. They know that it is a source of embarrassment for them and their loved ones to be mentally ill.  The delusions of grandeur common in persons suffering bipolar disorder isolate them from those who really care about them because we do not recognize them for what they are.  Or maybe, we just don’t want to.

In all reality, it is seldom that a person with a disease that causes delusions and hallucination has enough insight to understand that they are symptoms of illness.  It’s rare but not unheard of at all.  Do we make it easy for them to go to someone for help?  Do we make it as painless as possible for parents to admit to themselves that their child may have a serious psychiatric illness?  The same parents who would run to the ER if their child had a high fever is willing to write off increased moodiness. a decline in grades and the absence of friends as a ‘phase’.  We all want to believe that ‘there’s nothing wrong with my child’.  That attitude is about effective with mental illness as it is with cancer.  Deny it long enough and very, very bad things will happen.

So, the next time somebody suggests something totally preposterous to me, I am going to call them a ‘hypertensive’ or worse, accuse them of incontinence.  In fact, I’ll code them in their entirety, add all the numbers together and refer to them a 2530.21.  That will show them. 

Back to coding after this.  Send us some of the more interesting patient scenarios you run across.  We like a challenge.

And please be mindful of the language you use so that you do not unintentionally get between someone who needs help and help.

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