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01/01/2010 05:47 AM

Doctors - Can't Live With 'Em...Can't Live Without

ITeach91
ITeach91  
Posts: 1872
VIP Member

We've all seen the horror stories on this forum. Docs who don't listen, docs who say "mentally ill," docs who browbeat their patients. For every horror story, I am sure there is a lifesaving story. It is true, however, that it is most difficult for an adrenal insufficient patient to find a doctor who is well-versed in the illness. The diagnosis gets missed all the time. The problem is that it's a fairly rare constellation of symptoms and it's a rare condition in the populace.

I found a very useful list called "Signs That You Need a New Doctor," in the book Living Well With Hypothyroidism by Mary Shomon. Thought it would be useful to post the basics here:

Here are some signs it might be time to look elsewhere:

1) Dr. or his/her staff is disorganized, rude, not responsive to calls or faxes

2) Billing, appointment, paperwork mistakes

3) A refusal to look at your own research or medical log

4) Dismissal of symptoms as old age, overweight, sleep deprivation, depression, etc.

5) Refusal to try a different drug or protocol, without reasonable information/explanation

6) Selling of expensive products or services such as vitamin preparations, books, etc., that you can only get from the doctor

7) The taking of phone calls, reading of mail, typing on computer (unless it is looking up specifics he needs during the consultation) during your appt.

8) The asking of the same questions over and over, indicating he/she hasn't listened or that they haven't bothered to look in your chart. (Add to this apparent memory problems - even docs get Alzheimers)

9) Lots of drug company "swag" in the office - overwhelming number of freebies from pharmaceutical companies

10) Arrogant or patronizing attitude

11) Impatience or interruption when you are speaking. Irritation at being asked questions.

I'm going to add to this list from my own experience:

-Any form of disrespectful demeanor - raising of voice volume, rolling of eyes, etc.

-Statement that "you're in normal range" and thereby dismissal of all symptoms and lack of further interest in the fact that you JUST DON'T FEEL WELL!

-Docs who stubbornly insist that you should be on a static dose of meds without variation

-Docs who fail to see the "whole picture" and who therefore treat only one symptom at a time

-Docs who let you leave the office without having given good, solid information about how to live with your condition

-Docs who seem to feel their md license makes them omnipotent and they are not capable of making a mistake

Feel free to add to this...though it's bringing up some of that old familiar frustration I think it'll be helpful to all of us...

DebAngry

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01/01/2010 10:24 AM
LittleMissMerrySunshine
LittleMissMerrySunshine  
Posts: 1811
Group Leader

I'm a little concerned about New GP, although he was recommended by a friend who says he is just "overly professional", but chills out with each visit. So I'm giving him another chance. But I have three to add from him:

1. When I gave him my paperwork from the hospital, I had gone through and made "corrections" to the internist's notes, which were ALL wrong. I even asked the GI doc while in the hosptial to make this guy leave me alone. When I mentioned this as handing over the paperwork to the GP, I said to make sure to look at my corrections on Dr. V.'s notes, because he was an idiot. (I had been very ill for four months, so I think I should get a LITTLE consideration for being blunt.) He immediately whirled around and said, "That's not necessary. I don't think there is need to bring emotion into this!" I felt like a 5 year old.

2. He insisted I go back on my bipolar meds, which they had not given me in the hospital, because my mental condition could affect their ability to diagnose me - that my symptoms could be more pronounced or due to that - I wanted to wait on Addison's question, and he could have said it would help me. He was just kind of rude about that "mental illness" thing.

3. When I called the office to let them know my diagnosis, the receptionist asked me to SPELL Addison's. In my opinion, spell it like it sounds and ask a nurse or doc. Never ask a patient to spell their disease; makes them a wee bit freaked out.

If I start thinking of GI doc #3, I'm sure I can come up with another list.


01/01/2010 11:03 AM
ITeach91
ITeach91  
Posts: 1872
VIP Member

Oh and my personal favorite -

a doc who said to me, "If I treated every woman who was overweight and tired, I'd be a rich man." Grrrr.


01/01/2010 11:09 AM
ITeach91
ITeach91  
Posts: 1872
VIP Member

Merry,

I see a relationship between #1 and #2 on your list. He seems to have jumped down your throat for being overly emotional...unfortunately, seeing #2 in your record could make him jump to conclusions on that ground...

So good of you to give him another chance. Bob once said that when he goes into a doc he approaches it as a very professional encounter, prepares for it and acts the part fully...give that a try and see if the communication is a little better next time.

DebUnsure


01/01/2010 11:33 AM
tpocicat
 
Posts: 154
Member

The more I hear of other's problems with doctors, the more fortunate I feel that I haven't had too much trouble. I had one counselor propose that some of my adrenal insufficiency was caused by too much stress in my life, but I just figured that was because of her specialty, and didn't worry too much about it.

May all of you have a very healthy and happy New Year,

Terry


01/01/2010 02:53 PM
LittleMissMerrySunshine
LittleMissMerrySunshine  
Posts: 1811
Group Leader

Deb - fortunately or not, depending on how you look at it - when I called my friend and told him about that, he laughed and said he had done the same thing. The first time he saw this doc (& he has no mental illness history), he had severe diarrhea & was getting a second opinion, because another doc told him to go get a bottle of magnesium citrate and drink it! He didn't think that seemed smart, so he mentioned this "idiot doctor" and got a very nasty look, although I don't think he got as much commentary. Since they have a good relationship now and he felt like once the doc saw the records, he agreed just without saying anything else, I decided maybe he's just weird like that. And the last few docs I have seen, I have said things like, "Please note the corrections I have included. I do not think Dr. V. was very well-versed with my illness, so his notes should not be used for anything." Instead of saying he's an idiot, which he is. My corrections speak for themselves, anyway.

01/01/2010 03:08 PM
bob3bob3
bob3bob3Posts: 4213
Senior Member

Terry/Debs/Sue

Rather than pick negative events to make choices over I thought I'd put forward a few views. Its kind of long!

Doctor patent relationships are always a hard thing to define what is "right" over. Doctors supposedly have some base ethics yet professional conduct is very much a personal choice. I was surprised when I came to the US for example that you could get such a response by phoning a doctors office. I was more use to making in person visits.

How "much" do you really expect from a doctor and does that dovetail with their own way of doing things? You might expect them to preread all your documents, but they may only allocate 5 minutes of your appointment time whilst the nurse is measuring your BP. They need up front information of your expectations in a calm manner, preferably in writing. If they dont want to work at your level you have cause to find another doctor, but not to get mad at them. This is no different from finding a good plumber!

Most doctors follow the disspassonate and scientific view when it comes to diagnosis. Any kind of emotion from the patient tends to reduce their credibility in describing symptoms and issues. This is of course unfortunate and you'll find overt sexism as well. A male doctor will tend to believe a stoic male describing pain rather than a female crying over it. This is the reason I made the comment once before that especially for endocrine issues it is far better to have a female doctor that a male one. They will have a lot more empathy with pain and discord issues. Even I think a female endo is better because I have difficulty describing some symptoms! I should point out that there is nothing wrong with emotional distress and support for adrenal issues, just not in front of the doctors!

Doctors give opinions, not cures. Most of the time they work on incomplete information and statistical likelihood. You may feel testing is finite but it really isnt. Doctors also face an overwhelming number of people that if they left alone would heal themselves with their own immune systems. The "in your head" problem is also rampant. Its probably more a function of society and history but the in statistical terms a doctor is more likely to choose that diagnosis direction unless you do some really direct communicating and supply some major proof at first meeting. You have to convince them within a minute that you arent in these groups.

Agree to disagree with a doctor, but give them direction. Tell them that the problem isnt in your head and that you want a diagnosis as if it were not an option. ie make them think outside the box. When they object you simply say that they are not doing as you have asked. You are contracting them to do a service for you! If they bristle over that then yes its time to fire them!

When quoted normal ranges ask them how you compare to your tests of X years ago and why. You can also ask "under what conditions would these symptoms exist if the ranges were in normal bounds". Make sure you ask whether you can quote that to your specialist, GP etc..

Think about and document your symptoms in advance. Have someone else read them before you deliver them to the doctor to ensure that they are quantitative enough to get the message across. Saying you are "tired all the time" is far less meaningful than "I couldnt work more than 2 hours a day last week". Be specific with your descriptions. This is also the emotive vs science issue.

Take a friend/spouse with you, preferably of the opposite sex. Ask them not to say a lot or rehearse descriptions of major events. Ask them to stare menacingly if things arent going your way! <grin>

Emphasise that overweight, lack of sleep etc was a result of drug treatment and I really want get back to running/sleeping!

Many a doctor is like an amateur detective, they love to find something new or rare. So ask them, what are the possibilities that your ailment may not be common and to give you some ideas.

Engage them when you first meet, direct eye contact, hand shake. If you can make them laugh even better. It keeps your case in their head and stewing!

Outline your own problems with seeing the complexity of a problem and then praise them for their ability to separate the primary from secondary effects. I unfortunately take that too far sometimes and my doctor will assume I know the outcomes as well. You need to keep the questions and answers on track and not interrupt their views. Not only it is an opinion but could be a series of best guesses on their part.

If you think you have already been typecasted from previous visits, clear the air. Say things like "I bet you are sick of seeing me" and grin, then go onto to describe what research you have done as it relates to your condition. Be quick, precise and concise. Your credibility will then rise..

Ask them for views outside their specialty, apologizing so you dont make them feel trapped.

Okay enough ranting from me. I actually have a few other things going for me. Yes I research, I have an engaging accent. (woos the nurses!), I look sick, I walk sick/slow/carefully & and I am physically large enough that I appear to be a large but cuddly teddy bear!

Bob


01/01/2010 03:50 PM
LittleMissMerrySunshine
LittleMissMerrySunshine  
Posts: 1811
Group Leader

LOL Bob! I mostly agree with you. The "emotion" thing was definitely an issue with New GP, and I am keeping it in mind for his Second Chance. He was definitely fascinated with my case, and I tried to give him some credit since I walked in basically off the street with a ton of reports and said help! I took my stepmom with me to him and the new GI doc; I knew I needed a second person, but my hubby couldn't make it, and she is very medically "inclined" or well-versed. She stayed mostly quiet, but her presence and few but pointed questions seemed to give me credibility. Obviously someone else felt I was ill as well.

My endo is male, and because of various reasons, I did not expect anything to come of the visit. So when he just looked at my report and pronounced Addison's, I lost it. Only the second time I had cried in four long months, but he rolled his chair up to me and held my hands while I cried. Wow. I got myself together very quickly, just kept saying, "You mean I'm really sick? I'm not crazy?" Afterwards, I apologized, for which he said there was no need, then I asked him, "Are you always so nice to your patients?" He said he loves his job and loves his patients, and all he wants is for them to feel well and lead productive lives.

When I called a few days later and left a message for a nurse, he called me back himself. He also had me come in first thing the next day, since he did not like what he was hearing about my bp.

Other than my ob/gyn, who is also male, this doctor blew my mind with his kindness. He is definitely the exception to all the rules. I've seen tons of docs, and those two are the only ones who seem to really love and care about their patients, while letting down some of their professional barriers. I feel safe and cared for with both of them.

Personally, I have had several bad experiences with female doctors, so I'm not sure if your theory works for female patients as well as males. My experiences left me feeling like the female doc was more judgmental, had more of an attitude of "well I have THREE kids, and I still do this, that, and the other". That may be unfair of me, or that may just be a few bad docs, but I'm honestly uncomfortable with women as a general rule. I feel like the men look at me and see their daughters or their wives and have more sympathy. (But I'm also in the South, so this could be a regional thing.) I have female friends who feel the same way.

Unfortunately I will never come across as a teddy bear. Scary crazy bear, maybe, but not cuddly. Sad LOL


01/01/2010 06:06 PM
bob3bob3
bob3bob3Posts: 4213
Senior Member

Hi Merry

The answer of course is that everyone is different and you can never make judgments until you meet and communicate. I actually spent some years trying to "figure women out" <grin> although it was more a right/left brain analysis exercise. I guess I am good at telling people what they want to hear! Of course there are lots of ethics and beliefs tied up in such studies and that really is off the AI topic!

Being male I have tended to always see the science side of medicine. I have also worked in engineering and IT for many years so precision in communication has been very important in my general life. If I feel pain I will describe the levels and sensations as best I can and pull my own history of whether it may be a referred sensation. I'll also warn them about me jumping and inadvertently injuring nursing staff when they take blood etc! (I clouted by accident a nurse really hard once when she was changing a sticky bandage. Long story!) Interestingly I dont get emotive but dont rate that as a plus or minus. It's just how I am. When I was low cortisol in fact I was even colder emotionally, never got angry very placid etc etc.

The best doctor I came across was of course science based. What got me was his methodology rather than knowledge. He had a raft of questions to get into the right general area of the problem. Simply by talking/listening for 30 minutes he got 6-7 diagnostic possibilities, an echocardiogram all but proved one of them and a blood test another. I saw him for a follow up on a trip back to Oz earlier in the year. It was well worth it because his referral documents woke up a number of my specialists here in the US.

As corny as it sounds I think I tend to "charm" female doctors away from the science a bit. I guess I am always trying to get the most out of the visit so any technique is game! Must be a form of professional button pushing! Kind of hard to describe but hey it works. I have unfortunately also had some bad experiences pre diagnosis and with finding a good PCP/GP more recently but things are looking up. My original problem was of course very flaky and it took maybe 8 months to really get on top of it. I eventually however worked out that it was something physically wrong so I was able to pursue it better.

I think like I said the biggest barrier is credibility. Quite a lot of people complain about their ills bit arent really, and another lot dont complain about them and really are sick. It's very hard to make a call on your own health so doctors really should help in the analysis. I for example accept that pain can be in my head but I need to validate that this is where it comes from so I can safely ignore it! Once I can assign a body malfunction to a problem it makes life a lot easier! Knowledge is power!

Bob!


01/01/2010 07:16 PM
LittleMissMerrySunshine
LittleMissMerrySunshine  
Posts: 1811
Group Leader

Credibility is so tough, especially with that "mental illness" stigma. Then walking into a doc's office and listing the problems: tachycardia, endometriosis, bipolar II w/panic, chronic diarrhea/IBS, etc., etc. I felt like a hypochondriac myself! I have a small army of doctors! But I have to tell you, with the exception of the endometriosis, I now know that EVERYTHING was related to this. So at 24, during pregnancy, I had my first really noticeable symptom of what I guess you call adrenal fatigue (the tachycardia). Finally at 30 I have been validated!

I told my nurse at the ob/gyn's office, who has been SO kind to me via phone through all of this, that I could not wait to come in again and have them draw lines through all those "diseases/diagnoses", and simply write "Addison's". Now I think doctors will take me more seriously, because for some reason they can accept one diagnosis easier than a dizzying array of random ones.

I agree about the symptoms being in my head. When I went to see the endo the second time about the bp issues, I point blank asked him if I could be doing this to myself. I think that gave him some respect for me, that I have no issue with it. The brain is very powerful, and I'm willing to admit to it!

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