We’ve recently made friends with Equally Well, who are a collective working towards getting physical and mental health equity for people with mental health and addiction challenges.
We posted their video about overshadowing on our socials a little while back, which is super informative.
Overshadowing is where a healthcare professional has a preconceived idea about your health problems due to you taking drugs, having a mental or physical health challenge, or in some cases, being in a certain age bracket, from a certain ethnicity, being a certain size, or having a uterus; and uses that as an underlying cause for completely unrelated things, like a sprained ankle or earache. We’ve added it here in case you missed it.
Why are we bringing this up? Well…you don’t have to have a problematic relationship with drugs in order to have diagnostic overshadowing affect the way your doctor treats you. If you want to talk with someone about potentially starting management for ADHD or anxiety or you have chronic pain and you take drugs recreationally, this can affect the way your doctor treats you.
Do I really need to tell my doctor I take drugs?
It pays to be honest with them about what you’re putting into your body to make sure there’s no risky interactions between what you’re taking on the weekend and what you’ll be prescribed.
This can be tricky. As a patient you’re in a pretty vulnerable position because you’re trusting your healthcare professional to know what’s best to keep your meat suit working. You know if it hurts, or if you’re feeling sick, but you need the organic mechanic’s professional opinion on whether or not you need your body’s version of a full engine overhaul or just an oil change.
Also, health professionals are also pretty good at spotting things, especially in A&E. If you burn your lip because your pipe got too hot or crack your teeth from gurning too hard, they’re going to know how you got those injuries without you telling them because they’re pretty textbook. A good healthcare professional will patch you up without judgement and send you on your merry way.
How does overshadowing affect me if I take drugs recreationally?
If your healthcare professional’s biases get in the way of their assessment of a health problem it can be incredibly harmful, if not fatal. There have been anecdotal cases of people in Aotearoa going to their GP and being denied treatment because they took drugs recreationally.
One particular patient who took opioids was denied treatment for chronic pain because it was viewed as drug-seeking behaviour. The pain went untreated for so long that by the time the patient got to a doctor who believed them, the cancer that was causing it was inoperable. They died six weeks later.
Your medical records are forever. This isn’t necessarily helpful
Your medical records last for your entire life. Something that’s recorded in your 20s could come back to bite you in your 70s.
Elderly patients that have a history of taking drugs recreationally in their youth have been prescribed ineffective pain relief for degenerative problems like arthritis. The dose is set too low to ‘keep them from getting addicted’, which means that the patient is in constant pain despite being prescribed medication. If they go back and ask for a higher dose, it’s considered drug seeking behaviour and they’re put on a list and denied treatment.
Being gaslit about your symptoms is demoralising and really does mess with your head. It also adds an extra layer of horrible to the original problem that you’re dealing with.
We asked a GP about how to be honest and protect yourself at the same time
Dr. X* was willing to answer our questions about how you can make sure you get the best kind of treatment while being honest with healthcare professionals about the fact that you take drugs recreationally and not have it influence their decisions.
Your medical records
Your records are the notes that medical professionals will refer back to if they need to. This is where all the information about your medications, previous visits, and vital stats are.
If you change doctors or go for a second opinion, the new person will have access to these and use them to inform their treatment paths. The cool thing about your records is that they’re yours and you have control over what goes into them, and who’s allowed to use them.
Striking things from the record
If you go and see your GP or another healthcare professional, you can ask them specifically NOT to put things in your patient notes. And they have to comply because they need patient consent and patient confidentiality to treat you.
So if, for example, you have a discussion with them about some ongoing pain you’ve noticed after a night on ketamine where you might have danced through a sprain because ket’s a top-tier anaesthetic. You can say ‘off the record, I smashed about half a gram of ket over the course of the evening and didn’t notice that my ankle hurt until I tried to walk on it the next day, please don’t put this in my notes’.
The doctor will have that information to use immediately and inform their treatment programme, but it won’t be in your records or the consultation notes. Nobody in the future can refer back to it and use it as a discrimination point against you.
The key phrases here are:
“Off the record”
or
“I don’t want this in my notes”
Or both.
Ideally your doctor will ask if you want the information in your notes without you having to say anything. But if they don’t, it’s best to specify.
Password-protected files
If you’ve got your drug-taking on record, but need to talk to a different doctor, you can ask that your original doctor puts your records under password protection.
This means that your doctor is the only person who can go back through your medical records, and anything that you’ve told them about taking drugs remains between the two of you. This can be super useful if you need to get a second opinion about something.
Getting a second opinion
If your doctor isn’t helping, getting a second opinion is something to consider. Sometimes you do need to throw the whole doctor out and start again, and that’s ok. Generally the way to do this is to get your original doctor to recommend someone. If you’re not comfortable with that you can contact other practitioners and ask if they have an appointment free for a second opinion.
Red flags
It can be hard to know when your healthcare professional is failing you, unless they’re ultra-blatant about it. Red flags to watch out for are:
- Ignoring what’s actually wrong with you in favour of what they think is wrong with you
- Talking overtop of you and redirecting the consultation to what they think is wrong with you
- Gaslighting you about your symptoms
The Equally Well video at the beginning of this post goes into this list really well, so we won’t go too deep into it. Basically if you come out of a doctors’ consultation feeling like you haven’t been respected or listened to, you probably haven’t.
Talk to Equally Well about your experience
Talk to the Health and Disability Commissioner about your experience
Your doctor is meant to be your advocate
You don’t have to stick with the doctor you have if they’re not treating you right. You’re allowed to go to as many different doctors as it takes for you to find the right one for you. Like we said earlier, sometimes you might have to start over, and that’s ok. Ngl it’s tiring as hell and might test your faith in humanity a bit because stigma is alive, well, and causing problems. But you deserve good healthcare that isn’t tainted by someone’s opinion about what you do for fun.
*Name withheld for protection