As a profession, we must avoid the ostrich syndrome in our patient care.
An ostrich has an eye three times the size of its brain. Therefore, it sees way more than it will ever understand.
Several years ago, my doctor friends were leaving on a typical weekend to attend a medical conference out of town. A babysitter was taking care of their young son and daughter. While they were gone, my friends asked me to be “on call” as the designated backup mom and doctor. As an Internal Medicine doctor, I am not comfortable treating children, but I figured, at most, I’d be called upon to place a band aide and kiss a few bumps.
So when the sitter called to say that the boy had a rash over his hands and arms, I rushed to see what I could do. There is a saying in medicine that you never diagnose a condition you are not looking for. Our medical training teaches us to keep our minds open to differential diagnoses lest we miss the actual diagnosis. Consequently, on the way, my mind reviewed the causes of rashes in young children and what could be the problem.
There is poison ivy, poison oak, and allergic reactions to soaps or lotions. Could he have a viral syndrome? Lyme disease? How about a life-threatening meningococcal disease or strep infection? I reviewed the questions I should ask him and the sitter and my knowledge of common medication dosages for children. When I pulled into the drive, I felt ready to see the young man.
But I did not consider mental illness as a cause of the rash.
The Ostrich Syndrome, OCD & Medical Providers
The youngster was happy and well on my arrival, except for dry, chaffed skin from fingertip to elbow on both arms. He seemed a little embarrassed by my attention, but I was able to cross life-threatening possibilities off the list. Ultimately, I considered that he likely had contact dermatitis from exposure to some unknown allergen. The gentle soaps and creams I prescribed were no real help over the following days, and I anxiously awaited his parent’s return.
A psychiatrist made the correct diagnosis months later. The young boy had Obsessive Compulsive Disorder (OCD), and the constant hand washing chapped his fragile skin. As I think back on the situation, I did not consider mental illness as a cause of the rash. Like the ostrich syndrome, I saw more than I understood. Doctors will consistently and systematically miss mental illness if it is not considered in the differential diagnoses. Medical providers must consider the possibility of mental illness as the underlying diagnosis for a myriad of medical symptoms and physical findings. Our patients are counting on us for help.
Overall, mental illness continues to be overlooked, underdiagnosed, and incompletely treated. All medical providers owe it to their patients to stay educated and aware of the various presentations of mental illnesses. As a profession, we must avoid becoming ostriches in our patient care.
