My assumption is that the doctor would review proper hygiene with her and then find a tactful way to make a referral to a psychiatrist or psychologist. Is that correct?
What questions would the doctor ask? What language would she use when documenting this meeting? And what would she do when more patients start presenting with the same complaint?
In my story, the complaint becomes a pandemic. With this illness, it's always possible to wash away the dirt, you just can't keep it away. What are the long-term health consequences of not being able to remain clean? I know that it will increase the possibility of local infections but can you become ill from simply being dirty? (This hypothetical illness would only attract dirt, not pests. But would being dirty make it easier to attract and harbor fleas, ticks and lice?)
Thank you for any help you may be able to provide me!
Mental health evaluations are rarely done in the ED by an ER physician. These services are likely contracted out or handled by someone else other than the ER physician. You may have heard this phrase about ER docs, “Knowledge of all. Master of none.”—Meaning they have a significant knowledge base but are not specialists. Their job entails identifying a true medical emergency and managing that—so in absence of that, they’ll refer on.
I would say localized infection from open wounds is the biggest risk. As far as attracting other pests—what kind of environment do they live in? Just because you have extra dirt on you doesn’t mean you’ll have lice, etc.
I also ran you question by friend, author and ER physician Braxton DeGarmo.
The problem, though, is that everyone's psychotic break would be different. So, again, you’d have to build some case where they all share OCD or the opposite, an attraction to dirt to where they purposefully seek to get dirty. Both scenarios will require some work to build scientifically plausible causes.
Perhaps, there could be an illness that leads to a specific deficiency and the dirt they instinctively "collect" somehow fills this need and is absorbed through the skin. To the casual observer, they just look dirty, but a closer look finds common mineral “X” or whatever, within everyone's grime. And it's the only common factor, thus leading the protagonist or someone to figure it out.