Wednesday, January 14, 2009

The Problem with Lists (Updated)

A while back, I made mention of doctors’ dread of lists. Now, I love a good list. I make them all the time. For example, here is a list I made for one weekend day last month. (And I wonder why I feel pressed for time. The ones on the side, by the way, were the “possible if I magically morph into a superhero,” so I don’t feel too bad about all the blank boxes. I’m not sure why “side tables” merited an exclamation point, unless it was because I was unlikely to attend to them, as evidenced by the glaringly unchecked box next to that item. And yes, Aaron did come.)

I don’t mind most patient lists either. A list like this one is quite helpful.

But. A list like this one will give any clinician an overwhelming sense of being sucked into a vortex of negative energy. I have removed anything that might identify this patient in any way, but I will tell you that this patient is in their 20’s and is remarkably healthy, despite having had these symptoms for years.

Healthy, but not well. When you see a list like this, you know that you are about to embark upon one of the least satisfying clinical relationships in the world. Because this is a person who, for some reason, must be a Patient. This is a person who has no interest in being well, because they feel so rewarded by being sick. Why? I have no idea. Personally, I find being a Patient absolutely horrifying; I will deny that I need help until I am lying on the floor, and even then I’ll refuse to go to the ER.

Wanting to be a Patient has no relationship to how sick you are. I have one patient with a terrible neuromuscular condition who comes to my office on a ventilator, in a motorized wheelchair that he steers with the one finger he can still move a tiny bit. When I ask him how he’s doing, he has to wait for a puff from the vent to answer, “Great!” (I doubt my aversion to being a Patient would take me quite that far, but I like to think it would.)

It’s very hard not to take these list-writers by the shoulders, shake them, and shout “Get a life!” Maybe I should, because what I do—nod sympathetically, gently suggest exercise and possibly antidepressants, and try my best to avoid the unnecessary testing that will involve random false positive results that will then engender more testing—doesn’t seem to help much.

It seems a miserable kind of life, but then again, how would I know? Perhaps this feels like fun for them. Perhaps what they need is a Patient Theme Park: giant stuffed medical personnel walking around and giving injections, an MRI Tunnel (with Realistic Banging Noises!), a 24-Hour Urine Collection Log Slide, lots and lots of blood draw concession stands, a place to pose for overpriced photos of yourself that make it look like you’re intubated, and people hawking baseball caps emblazoned with Another Sufferer of A Really Rare Disease Whose Doctor Totally Dropped the Ball* and t-shirts that read I MAY LOOK FINE, BUT I KNOW MY BODY.

*Not that this does not ever happen, OF COURSE. I have dropped a few balls myself. However, most bad things will “declare themselves,” as we say; they get worse and become diagnosable. Not-bad things usually go away, and the less you test for, the better off you will be. As I teach my residents, “follow” is not a dirty word.

UPDATE: To all who are saddened/angered by this, let me say a few more things:
  • There are many, many crappy doctors, I know. Believe me, I know. I do not excuse any of them. They’ve messed me up too.
  • Most of us have had frightening, unexplainable symptoms at some time or another. That doesn’t make us Patients.
  • Yes, most people just want someone to listen carefully and, if appropriate, reassure. I love listening to people, watching them, finding out what it is that frightens them about their symptoms. I’m not talking about those people here. I’m not talking about you here.
  • There are a few diseases that have multiple seemingly unrelated symptoms that can be overlooked. I test for these where appropriate. That patient who wrote the list? Had had multiple tests already.
  • These folks can get sick too, and that’s frightening, because they do fall victim to the crying-wolf problem. It’s part of what makes them so tough as patients.
  • There are also, I am quite sure, many diseases that we cannot yet diagnose no matter how many tests we do. We doctors must remain humble about this.
  • And know this: if you’re suffering, I wish I could help you.

38 comments:

Orange said...

When the urine log flume is extra bubbly, the park attendants will know that the protein level is too high.

I can't believe your negative vortex patient didn't mention a pesky hangnail and a bit of ear wax blockage, too.

My relatives and I had to take the grandmas to their doctors for years. One would dolefully report a lack of "pep" every single time. The other would give a detailed description of the pain in her leg that sometimes woke her up at night, for which she had been given the exact same advice at every previous office visit, usually at an interval of every 3 months. Their docs were endlessly kind—me, I do not have that sort of patience—and never once shook them by their nonagenarian shoulders; they just repeated their advice and declined to order any further workup.

Kirsten said...

That patient (list writer #2) might benefit from reading something by Dr. John Sarno.

Jul said...

I'd be tempted to dust List Writer #2 with stray carpet-fluff and tuck a flyer about Morgellon's into their purse. Mwa ha ha haaaaa.

Personal theory on list-writers? Peoples' lives expand or contract to the amount of "stuff" in them - activities, challenges, stressors. The smaller the quantity of "stuff", the greater the temptation to inflate the everloving hell out of it. It's easier to make niggling aches and pains dominate your existence than to acknowledge, "Gee... I don't really have a life." I (unfortunately) know of whence I speak.

What chaps my ass is that these people usually have health insurance (insert "awful drain on awful situation" discussion here).

Just me said...

This list reminds me of a particular family member of mine who has been diagnosed with a (disorder? disease?) but it's one of those unspecific, generalized disorders that don't have specific symptoms, treatments, medications, etc... This family member has always been a bit of a hypochondriac who enjoys attention. It's hard for me to grasp what issues stem from the diagnosed disorder (if any) and which are just part of this person's personality and I have to accept as such.

Miraculously, this person is now in "remission" - again, I wonder if this is medically/chemically produced or because another way to gain attention arose.

E said...

Geeezz
I don't even know what else to say about this list
And I thought I had it bad with birth plans!
Your favorite OB

drcathy said...

This list was just in my office:
*I have parasites, bacteria, silicon poisoning and blood flukes!
*The flukes laid eggs in my middle ear canal!
*my energy doctor pulled them into my GI tract so they came out in my stool - they were huge worms! - but the lab results came back negative.
*Do you think I have them in my brain?

sigh.

Anonymous said...

Hmmmm...said patient seems suspiciously close to being a "Fibromyalgeur" or some other BS of that ilk. One of the myriad reasons I rue having gone into medicine, and breathe a sigh of relief I chose anesthesia. I admire your patience :)Seriously.

Orange said...

Jul and drcathy both had me laughing out loud. {checking skin for extruding fibers now...nope, all clear}

The nutty patients who concoct problems and thereby repel a lengthy parade of doctors are really screwed if they come down with something serious. My aunt dumped doctor after doctor because they didn't take her "problems" seriously. Then when she had actual symptoms of serious disease, it was all too easy for them (or at least the sole MD she hadn't "fired") to dismiss her as a loon. I hope very few of these list-makers end up with ovarian cancer like my aunt did.

Heidi said...

I had a list like that. Different symptoms but same idea. I knew something was wrong but didn't know what, so I made my list as thorough as possible because - well, that's what everyone says to do. I might not think my big toe and my shoulder are related, but someone who's studied the body for years might know about something I've never heard of.

Anyway, I was eventually diagnosed with a few things, one of which was thyroid disease, and when my thyroid was properly managed many of my symptoms subsided.

All that to say my list was much more about my trust in my doctor than it was about wanting to be a patient. I know not every patient who makes these lists does it for these reasons, but I just had to speak for those of us who do like and respect our doctors and are dealing with underlying yet-to-be-diagnosed issues.

Anonymous said...

Oh, dear. I fear I am one of those dread hypochondriacs. I once went to my dr. complaining of shortness of breath, and my lung capacity turned out to be 115% of normal! (Blush.) Vascular disease runs in my family, so I have my hsCRP tested annually; I asked for a carotid ultrasound at age 38. My PCP is a saint who always pretends to take me seriously, is very kind and patient, and never betrays any irritation. -victoria

Anonymous said...

Before being diagnosed with lupus at 17, I used to compile lists eerily similar to this, albeit with more specific symptoms. Reading this post made me want to cry - by the time an illness "gets worse," life-changing sacrifices have often already been made.

In high school I still went to a pediatric practice, and half the doctors acted like I was the attention-seeking, crazy person you describe. It wasn't until I started having seizures and serious kidney problems that someone thought to refer me to a rheumatologist. I am now a senior in college and doing great, but had doctors listened to my lists, I would not have had to be so miserable for so many years.

heather G said...

I freely admit to hypochondriac tendencies but treat my GP like a placebo. I trust him implicitly and if he says "you're fine" then amazingly the symptom generally goes away. When I was super crazy he said "take an anti-depressant for 6 weeks and then we'll see if you still want to be tested for...Sure enough I was feeling all better by then. Arapax gooood.

Jul said...

Another aside(att'n, real doctors - feel free to tell me I'm full of shit). I think there are three things Professional Patient types cannot and will not acknowledge:

- Medicine, like everything else, involves a fair amount of guesswork. Not random guesswork, mind you ("Huh, that looks kinda aorta-ish"), but gathering and evaluating all available evidence against one's accumulated knowledge/experience (as well as that of the profession as a whole).

- Assuming there's no gross incompetence or negligence, that's probably what your practitoner(s) do. Gather evidence, evaluate, take-a-whack-at-it. Add Occam's Razor, shake, serve over ice.

- Your level of distress does not factor into this equation (well, except for stuff where "causes significant distress" is a diagnostic criterion). While a sympathetic physician may do so anyway, back-pats, hand-holding and poring over a symptom list like it's the Merck-na Carta are NOT critical steps in making a diagnosis.

Anonymous said...

I'm glad anonymous and Heidi spoke up. I typed out comments to this post twice and deleted them because this post made me so angry.

These lists have a lot to do with trust. When you have had malpractice committed against you (in the form a foreign body being left in you) and then are IGNORED for a WEEK by THREE DOCTORS and it isn't until you DISCOVER IT YOURSELF (it was in my vagina, btw - postpartum), well? You tend to make lists like that. Because you no longer trust doctors.

Anonymous said...

Ouch. Yep, me too. I had "wind" which turned out in actual fact to develop rapidly into a torted ovary. Did they diagnose the ovary thing immediately? Nope again. Left me for a few hours to "clear the kidney stones" whilst my tube blackened and died, causing the loss of half of the meagre fertility I possessed.

FreshMD said...

Great post and interesting comments.

I don't have a problem with patients bringing in lists of symptoms. Sometimes it's helpful to glance over all the problems and prioritize at the beginning of the visit, rather than having the chest pain be brought up as you're walking out of the room. And sometimes a pattern does emerge from seemingly disparate symptoms.

It's the list of instructions to the physician that gets me. "Insisting" on a particular workup up front is a sure way to land on the physician's own list - of patients whose names make your heart sink when you see them on your day sheet.

On another note, I work at a refugee clinic where somatization is the norm. Fatigue, right shoulder pain, burning to the scalp, bugs in the brain etc. almost always respond to sertraline. These patients want desperately to be well, are generally compliant and never bring in lists - because I can't read Farsi/Kirundi/Burmese.

Anonymous said...

I, too, am glad anon and Heidi responded as I deleted several drafts because this post made me sad and angry. I've had a specific pain issue for years now and when I first brought it up, they did one test, and when it came back normal, they proceeded to tell me I was making it up (yes, after one test). When the pain didn't go away, I tentatively brought it up a year later at my next annual exam (after trying to manage the pain for a year) and when they saw I'd had a test a year before, brushed me off again (asking this time if I wanted some antidepressants). So now, I'm just waiting for something to "get worse" before I feel any doctor will believe me. I'm just afraid "get worse" will be something way bad, but if I mention THAT fear, I'm definitely going to be labled as a hypochondriac or wanting to be a "patient."

So I chalk it up to too many people like #2 that make doctors assume that some patients are "automatically" number 2s and thus don't take us seriously.

I mean, seriously, one test? One test comes back normal and I'm faking it?

For the last few years, I still mention casually at my annual exam in terms of, "Oh, yeah, still have that pain in XXX region as always..." and never fail to get a simple nod from the doctor before she moves on to the next part of the exam.

C. said...

When you posted, you know you were going to get some naysayers. Agreed with the lists and the incessant patients who must be sick but here is the rub. My sister suffers with a very severe case of a rare auto immune disease. She was in the ER twice for extreme pain after doing the proper thing and seeing her primary care.

Her primary thought she was a hypochondriac and prescribed an anti anxiety when she complained of shortness of breath in addition to severe pain and inability to move (a result of the disease). The first ER doc claimed she was a drug seeker despite her extremely elevated SED levels. The second ER doc finally treated her symptoms but it took EIGHT months and many, many doctor visits with many, many specialists to finally get someone to listen and then a diagnosis and finally a successful treatment. If the first doctor listened to her instead of sending her off with a script for anti anxiety meds it probably would have been a little easier navigating and getting in to see the necessary specialists.

All im saying is dont dismiss so quickly.

Old MD Girl said...

Psychiatry referral?

This is why I cannot do primary care.

But also? I don't trust doctors myself, so maybe I'm the one who needs the psych referral.

I think many of these patients really just want to feel listened to.

Caustic Cupcake said...

The commenters who disagreed with this post cited specific instances of doctors who just wouldn't listen. It's easy to remember malpractice, but harder to remember that for every time a doctor overlooks something that turns out to be important, there are many, many more cases in which a doctor overlooks something that deserves to be overlooked.

Doctors make their decisions based on the information they have, and an informed decision that turns out to be wrong is still an informed decision. Blaming your doctor for not taking the road less traveled by following up on an improbability is an outcome bias.

I agree with what FreshMD said; it's not the list of symptoms that bothers me (although the capitalized words for emphasis were grating), it's the list of demands at the end. The patient seems to expect confrontation. How could someone who expects to be contradicted by a medical professional not consider that he or she might be wrong? Isn't the expectation of disagreement an acknowledgment that "I know I sound crazy"?

4th year said...

I think the list is fine, but the orders for the physician are not.

C. said...

The job of a doctor is difficult, and determining the crap from the real is incredibly difficult to be sure. However, what I described was not and is not isolated. My sister went to doctor after doctor in a well known, well respected medical community, only to have her symptoms dismissed because no one wanted to listen to what she had to say and perhaps do a little research. We did our own research and eventually she ended up demanding tests to rule out certain diseases and ultimately diagnose her clinically. She ended up suicidal (yes it sounds dramatic, but its true) from the extreme pain and the lack of pain management because again, she was accused of being a drug seeker; someone who never went to the ER, was not known in the ER or known to her PC as a drug user or seeker. It was a very long, painful time for her and a very stressful, helpless time for her family.

Personally, I was sent out of a gastro office with a script for an ultrasound and a laxative for what was clearly biliary colic. The ultrasound came back positive for gallstones but the doctor insisted it was a kinked colon. I ended up in emergency surgery for an infected gallbladder.

My point again is being a doctor is not being a god and sometimes, just sometimes, patients know what they are talking about and know what is right and wrong with their own bodies. Projectile vomiting and severe pain as never experienced before was not normal for me and the feeling of having hot swords penetrating her body was not normal for my sister.

Needless to say I found a new gastro and she sees a different PC.

Anonymous said...

I suspect that I'm a lot older than most of the doctors commenting on this post, but had you been practicing in the 1970s, you would undoubtedly be complaining about me.

I was a total Patient - a twentysomething, perfectly healthy (but not well) woman who presented over and over again with the same list of complaints:

- Four to six times a month, I got a metallic taste in my mouth, followed by:

- A debilitating headache lasting a day or more, with:

- Sensitivity to light, and:

- Vomiting, which usually ended the whole sorry episode.


Back in those days, the "antidepressants and exercise" brush-off wasn't yet in vogue. Instead I repeatedly got a pat on the knee and instructions to go home and get pregnant to give myself something to think about besides the headache.

After making myself persona non grata at all of the local doctors, I gave up. I just stopped complaining and learned to live with the condition.

It wasn't until 1996 that I mentioned it offhandedly during a physical. I was finally diagnosed with (drum roll, please) migraine - easily controlled by trigger avoidance and triptans.

I'm sure that my doctors thought, "Oh well, if the headaches are really serious, they're bound to get worse and therefore diagnosable."

But I lived with this for twenty years of my life, and all because I let my doctors shame and chasten me about my "hypochondria" and "hysteria."

I just wish I'd been confident enough to wear the t-shirt reading, I MAY LOOK FINE, BUT I KNOW MY BODY.

Anonymous said...

Thank you for the update. I've enjoyed your blog for a long time and I was hoping you would join this conversation.

I'm the anonymous with the foreign body. I also happen to be a lawyer. And being a lawyer I know that there are a lot of crappy lawyers out there. Not crappy in the sense that they sue people who shouldn't be sued or are jerks or anything like that. Most lawyers are incompetent.

They might be competent to do XYZ, but they definitely aren't competent to do ABC. Or they get old and lazy and don't realize that the law has changed on XYZ and become incompetent.

I now believe that most doctors are incompetent as well. Sure, they are competent for ABC, DEF, GHI, but 123? Well, no way.

But people are scared to look ignorant. Even doctors. Especially doctors.

So the doctors (and lawyers) that I respect are the ones that say "I don't know." The doctors that I respect even more are the ones that say "Let me take a look." (It's amazing how difficult it can be to get an actual physical exam - thus me discovering the foreign body, thanks to a hand mirror).

So thank you for admitting that there are diseases that have not been discovered, but nonetheless exist.

Your judgment on Patient #2 is probably 100% spot on. But I am glad to know that you remember even the patients who cry wolf get sick.

town mouse said...

I have no comment on the second and third lists but I am awed by your first one - particularly the little boxes all ready to be checked off...

Anonymous said...

I guess what bothers me here is that the 2nd patient's note seems to be TO HERSELF. I.e. not meant for your eyes. Ergo: So what if you find it offensive. It wasn't meant for you to see in the first place.

Maybe she has a hard time asserting herself. Maybe these problems have been bothering her for a while and she feels repeatedly blown off. Haven't you ever had thoughts/fears that you don't want the rest of the world to know?

You and she are having some sort of communication problem. She frustrates you. You make her feel like you think she is neurotic and dependent.

If she really makes you this crazy, maybe you should have a conversation with her about how you really want to help her feel better, but you feel like she doesn't trust your judgment, and that makes it hard for you to work with her. If you still can't work with her, maybe you should consider sending her to someone else.

DoctorMama said...

Anonymous with X pain—“I'm just afraid ‘get worse’ will be something way bad, but if I mention THAT fear, I'm definitely going to be labeled as a hypochondriac or wanting to be a ‘patient.’”—if you saw me, absolutely not. I TRY to find out what the fear is, so that I can explain how I know that the symptom is NOT something terrible. And your doctors may suck, I don’t know, but sometimes one test is enough to rule out the one dangerous possibility suggested by a symptom. And sometimes, if you have something painful that can’t (yet) be diagnosed, it can be depressing; I wouldn’t assume your doctors thinking you’re “faking it” (though again, some doctors will stupidly assume this).

Anonymous with torsed ovary—that just happened to a friend of mine; she wasn’t screaming in pain because she’s tough, and they assumed it was just some pain from her recent (successful) IVF. They were able to save her ovary, and the embryo hung on despite emergency surgery, but it was a scary time.

FreshMD—“‘Insisting’ on a particular workup up front is a sure way to land on the physician's own list - of patients whose names make your heart sink when you see them on your day sheet.” Yes, and I’m not quite sure why, because I’m a strong advocate of patients ultimately being in charge. I guess it’s just a little insulting; first see if I might already agree with you before assuming that you’re going to have to insist? I don’t know.

Old MD Girl – “I don't trust doctors myself, so maybe I'm the one who needs the psych referral” – I don’t trust most of them either, sad to say. I do have a psychiatrist, though.

Caustic Cupcake – “It's easy to remember malpractice, but harder to remember that for every time a doctor overlooks something that turns out to be important, there are many, many more cases in which a doctor overlooks something that deserves to be overlooked.” Yes, and thank you, but I would say these things should not be overlooked so much as heard, acknowledged, and reassured about.

Blogger C. – I was once admitted to the hospital for acute appendicitis when what I really had was glomerulonephritis – as I say, I’ve been there.
The “I know my body” thing is kind of an inside painful joke among doctors, but it’s actually usually said not by someone saying that something is wrong, but someone who is declining treatment for something we HAVE diagnosed. (Which is fine, it IS their body, it’s just … I don’t know, hard to explain.)

Anonymous with migraines—geez, I had my first migraine in the 1970s, and my doctor had no trouble diagnosing it—I’m sad that you had to go through that. I don’t think I’ve ever NOT treated episodic headaches as migraines at least to see if it would help. (There weren’t triptans in the ‘70s, but there was SOME treatment.)

drcathy—love your list.

Victoria—I’m sure your doctor never gets irritated with you; you’re too nice.

Anonymous with SLE—I am happy that you are doing well. I hope you have a good doctor now?

My favorite OB—uh-oh, better not open the birth plan can o’ worms …

Jul—you’re never full of shit. Well, almost never.

Anonymous with foreign body – “the doctors (and lawyers) that I respect are the ones that say ‘I don't know.’” You are SO RIGHT. I even put this on the evaluation sheets that I have students use to evaluate their residents and attendings: “Willingness to say ‘I don’t know.’”

Last Anonymous—I didn’t find the list offensive; I found it troubling and frustrating. And as a matter of fact, she isn’t even my patient; she’s the patient of a physician I advise.
The idea of shuffling every tough patient off onto another doctor may be tempting, but I don’t think it’s right to fire a patient for being frustrating. If they want to fire ME, that’s another thing. I’ve almost never had it happen, though.

el said...

So, when I am at my doctor's office (doctor is very involved in med education) and she sends an intern or student in to see me first, and I, helpfully, tell them everything I can think of in order to give them practice in sorting out essentials, am I really doing a bad thing? el

Anonymous said...

I have to say that 2nd list left me wondering "Where does a clinician start?"

And yet, I am one of four in my family.

My mom was sent to a dietician, after complaining of weight gain and excessive fatigue (2 appts. over 6 months). PC sent her to a dietician after the 2nd appt. She died of ovarian ca less than a year later.

My Dad complained to a different PC over a period of 10 or so years of heartburn after spicy food. Doc refused referal to a gastro, and told him to take TUMS. Last year? A esophagogastrectomy for stage III adenocarcinoma. He's barely hanging on.

Another PC told my brother that his toe must have become sprained in his sleep. 4 times over a period of 4 months. Who knew a 30 year old could have gout?

And it took 3 MFMs to find the protein c deficiency that caused too many 2nd tri losses for me. 2 perinatalogists had done the equivalent of patting me on the knee while telling me 'that these things just happen...' Really Class I HELLP, then a string of 20 week losses (chromosonally normal karotype)? ARGH!

So maybe the irritation goes both ways? Maybe disappointment and distrust too.

You struck a nerve, DM!

Sharon/Anon

Heidi said...

I totally have to clarify (lol... I am SUCH the obsessor) that when I said trust I meant that I actually trust my doctor, and when I present him/her with my list, I'm doing it because I trust that I'll get an honest and thorough response, and I trust that s/he's more educated than me. I also trust that (thankfully) my doctors trust me and my instincts, so in a sense I feel free to make the lists because I know they'll be honest in both directions - if I need further tests or if I need to go home and meditate. lol

I've had a few crappy experiences with medical professional, but by far I've been fortunate that I've had excellent, empathetic, trusting doctors. I wish that was the norm for everyone.

CS said...

It's intriguing to read this post and these replies. My 22 month-old son has an undiagnosed congenital condition (hypotonia that has lead to several secondary conditions). If he were an adult with these same symptoms, he would probably be in the frustrating patient category because the symptoms he has could seem a little benign when looked at individually. And yet, he’s fed through his stomach, he has a trach, he is on a ventilator, he receives several types of therapies, and of the many, many doctors he has seen, no one has ever brushed off any of our concerns. Of course he needs all of these things, many of which are life sustaining for him, and I appreciate more than anything that the doctors are so vigilant. It's just interesting to me that a child's problems cause doctors to jump into action and many adults feel neglected by the same medical community. Or is it the same community? Is it because adults can be annoying? I ask these questions seriously.

I have a friend who is a Patient. She told me she can’t have a mammogram every year because she isn’t over 40, as if she WANTS to have a mammogram every year. Who wants to have a mammogram every year if it’s not needed?! She has fatty tissue she just *knows* is going to turn into something. I have a fatty tumor in my arm that’s been there for 12 years and I only think about it when I lift weights and it’s noticeable and only then because I'm vain. I’ve never thought about going to a doctor to have it checked out just in case. What’s the point? I could see where my friend's doctors’ may put her on a frustrating patient list because she always has symptoms where as most of the rest of us just have weird things. And they probably don’t realize she is a compassionate, caring, wonderful person because her “symptoms” mask all that. It’s all very interesting to me.

Just me said...

Did you see Real Simple Magazine (my MIL's favorite mag)this month? The cover says "20 ESSENTIAL LISTS to organize your life." Didn't look like any of the lists were for your doctor. ;)

MDT said...

Wanted to add that I worry a LOT about being That Patient. I was lucky enough to find a really amazing OB/family practice physician during my 7-week pregnancy and after I miscarried I stayed with her as a general patient. The sheer amount of respect I have for her makes me worry about making an appointment, for fear that I'm just wasting her time. I am almost tempted to just switch to a doctor who I don't like as much so I can go in when I feel I need to without stressing about inconveniencing him or her.

E. said...

I can tell you're a good doctor by your "Update" list. You obviously care a lot. Which probably makes treating professional Patients all the harder, because you cannot help them.

Mignon said...

I wish you were my doctor. I could pay you in mix tapes.

kathleen999 said...

I just wanted to mention that some of these things, like chronic pain in certain areas of the body, might be something better helped by alternative medicine. I see a chiropractor for aches and pains, some of which are the result of a sprained back at 12 years old...never been the same since. Some just due to stress. Acupuncture cured my asthma and greatly reduced my allergies. These alternative therapies have their place, and to my mind, the place is for those things that doctors tell you they can't do anything about. Maybe doctors can't fix my shoulders, but the chiro sure can! Everything has its use.

Also, both my mom and my MIL have fibromyalgia. It is a real disease and both of them have challenges from it. It is not BS, whoever said that. My mom is in a lot of pain every day from it. She is not a hypochondriac and doesn't talk about it a lot. Her doctor diagnosed it and is treating her with small doses of antidepressants for it. Additionally, she got a hot tub and soaks in it once or twice a day when the pain gets bad and that helps tremendously.

Anonymous said...

Sorry I'm late to find and comment on this post. There actually is hope for the somatizer, which it sounds like might be your listy patient's main issue.

In my psychiatric residency training, I worked at a centre (Dalhousie) which focused specifically on somatization, diagnosing it and treating it successfully with short-term psychotherapy.

Here's a paper my supervisor published describing clinically observed patterns of anxiety discharge due to emotional dysregulation, and a guide to help GP's dip a toe into the water of looking at emotional dysregulation with their patients, the white elephant in the room.

http://psychiatry.medicine.dal.ca/centreforemotions/Somatization.pdf

clueless carolinagirl said...

Fibromyalgia? Been going to my GP for 15 years. Had total hyst for suspicious cyst then I was found to have Stage 3 endometriosis (so much for all the doctors who refused strong pain meds for cramps)

Made quick, uneventful recovery, as I was a perfectly healthy 48 year old who never got really sick, had never spent a night in hospital before the hyst (and only 1 night then).

6 weeks later I jumped out of bed feeling great and by the end of the day I was in horrible pain from....Fibromyalgia. Jan 8, 2007. My GP took me seriously because he knew me.

The great news is that guaifenisen works and I feel much, much better today. Fibro people, please, please, please try the guai treatment. Peer reviewed research is now coming out of the City Of Hope in LA supporting it. Google Dr. St. Amand.

There is no blood test for fibro, but I'm here to tell you it's real, and I despise hypochondriacs, and had a long history of my doctor asking me why I waited so long to come in when I had a bronchial infection, etc.