The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction

Internal Medicine Residents’ Attitudes Toward Simulated Depressed Cardiac Patients During an Objective Structured Clinical Examination: A Randomized Study

“…This is different from studies in real-life situations, where patients with a charted history of depression received a lower-priority triage score than did those without a documented history of depression. 5 It may be that residents in our testing situation chose the correct workup plan, as AMI has been taught as a Brule-out^diagnosis in acute chest pain. Alternatively, awareness of the simulated patient encounter and the nature of the encounter as an assessment of resident skills may have made the residents more acutely aware of their decision-making, and that awareness may have helped them overcome any potential cognitive bias.…”

“…A self-report questionnaire, the MCRS, was used to measure residents' extrinsic bias toward depressed patients. This instrument assesses Bwhether students find particular medical conditions to be enjoyable, treatable, and worthy of medical resources.^1 5 The scale consists of 11 items with six anchors ranging from 1 (strongly disagree) to 6 (strongly agree). Scores range from 11 to 66, with higher scores representing higher regard for the condition.…”

“…Research has shown that, when presenting to the emergency department (ED) with chest pain, patients with depression were more likely to be triaged to a lower level and to experience a longer wait time before receiving an EKG or fibrinolysis, and were nine times as likely to miss benchmark times in receiving a balloon procedure, even with a prior history of acute myocardial infarction (AMI), than someone without a comorbid diagnosis of depression. 5 Beyond the ED, people with a history of depression were more likely to be referred to low-quality surgeons 6 and lower-quality hospitals 7 and were less likely to receive percutaneous transluminal angioplasty or coronary artery bypass graft surgery. 8 Patients with acute myocardial infarction who also had mental illness were marginally less likely to receive diagnostic angiography.…”

Do Nice Patients Receive Better Care?

“…Many studies have examined the influence of specific patient characteristics, such as race, sex, socioeconomic status, or even labels such as depression, on specific types of care. [6][7][8][9][10] The results of these studies may or may not apply to the constructs of "nice" and "better. "…”

Sense and sensitivity

“…Patients with mental illness are more likely to delay seeking future care, which is likely a contributor to the increase in mortality among these patients. It has also been shown that people with mental illness have less access to primary care, and receive in ferior management of myocardial infarction 4 and diabetes. 5 There may be no straightforward solution to the problem of diagnostic overshadowing, but a start would be to acknowledge its existence.…”