more on speaking up

Thinking about doctor-patient conversations sometimes reminds me of that old Simon & Garfunkel song:

…I’ve come to talk with you again…

…I walked alone…

…people talking without speaking
people hearing without listening…

If doctors need to listen to patients to figure out what’s going on, patients need to tell doctors what’s going on.  Why is that so hard sometimes?  It’s hard to speak up when you feel rushed, but have doctors ever done other things that made it harder for me to talk to them?

Sometimes Doctors Blame the Patient

Years ago I got a terrible abdominal pain.  I could only explain that it felt like the stitch you get in your side sometimes when running.  Since I hadn’t been running, and it continued for days, I finally called my family doctor.  Unfortunately, she didn’t have any openings in her schedule so one of the other docs in the practice saw me.  Another symptom – very weird, and not one I exactly wanted to announce – was that the pain got worse when I used the bathroom.  The doctor learned this only based on questions that he asked (I certainly didn’t volunteer the information), then this obnoxious person told me that perhaps it hurt because I expected it to hurt!  I didn’t say anything else; I was done talking to the jerk who seemed to simultaneously dismiss a fairly painful/embarrassing problem, and blame me for my symptoms.  I’d been using the bathroom just fine for 24 years; why on earth would I suddenly start thinking it would hurt?   My expectation was that I would not live in pain.  When that doctor then asked if I’d be comfortable with him doing a pelvic exam, I told him Not.A.Chance.  DrJerk left and my doctor made time to see me.  She discovered a grapefruit-sized ovarian cyst.

Experiences like this color future interactions with other doctors.  Don’t say anything that might be interpreted as something for which the patient could be blamed.  When a doctor wrongly suggests,  “It’s your fault that you feel this way,” that’s a sure-fire way to guarantee that I’ll clam up.

…No one dared disturb the sound of silence…

I can only think of one other time that I was blamed for a medical situation.  Tramadol was prescribed.  In the first place, I didn’t want to mask symptoms with pain killer; I wanted to solve the problem so that the pain killer wouldn’t be needed.  However, I was desperate so agreed to take the tramadol.  The instructions I was given said take 100mg up to four times a day.  Within minutes of taking my first (and only) dose, I felt horrible:  the room started spinning, my speech was slurred, and I was extremely nauseated.  Then I began vomiting.  It was so awful that I couldn’t eat anything for the next three days.

The prescriber’s response was to blame me, “It looks like you’re medication sensitive.”   By that time I’d done a little research – including a long conversation with my PCP.  This was not a case of being overly sensitive to the medication.  The prescriber screwed up and told me to overdose.  This particular medicine, “should be started at 25 mg/day qAM and titrated in 25 mg increments as separate doses every 3 days to reach 100 mg/day (25 mg q.i.d.).  Thereafter the total daily dose may be increased by 50 mg as tolerated every 3 days to reach 200 mg/day.” 

Although it would be easy to go on and on in a rant against that particular prescriber, I’ll refrain.  The point is that he blamed me.  He’d made up his mind and was stuck on a specific treatment track without being open to my input.  In response, I was no longer willing to talk to him.  Sure, I showed up for follow-up appointments, but I didn’t volunteer any information that he didn’t specifically ask for.  I was done talking to him, and hated having to see someone like him.

…”Fools,” said I, “You do not know.  Silence like a cancer grows.”…

What’s a Patient to Do?

If we can’t talk to our doctors, they can’t help us.  At least not effectively.  Like a harmful cancer, silence between doctor and patient needs to be eradicated.

In the spirit of not pointing the finger at others, the most obvious solution to the blame game is to avoid being at fault.  For instance, if I don’t want to be blamed for being non-compliant, then I shouldn’t be non-compliant.

Sometimes faultlessness isn’t sufficient.  As my two examples show, sometimes the patient gets blamed anyway.  I think there are two possible solutions when this happens.  The first is to address it directly.  Without being overly confrontational, it’s possible to say that it seems like you’re being blamed for something unjustly and would like to know why and if there’s any way to fix the problem.  It might be a simple misunderstanding; you’ll come out of it with a better relationship with your doctor, knowing that you can speak up and will be heard.  The other option is to find a different doctor who won’t place blame when it’s undeserved.  I’m not a big fan of doctor-shopping, but on rare occasions it might be needed.

There is one other situation, though.  Sometimes we might be blamed for problems in our health because we are to blame.  What a concept!  Personal responsibility.  Instead of getting offended and refusing to talk to the doctor, hard as it might be, wouldn’t it be better in the long run to admit it when we screw up and ask for help fixing the problem?

That seems pretty reasonable:

  • Do your best to not be at fault
  • If you are at fault, admit it and move forward
  • If you’re unjustly blamed, address it

Let’s respectfully speak up instead of letting blame create even more silence.

********

________________
Post Script – This is part three in a series of (at least) four posts on doctor-patient communication

  1. Speak Up  
  2. Hindrances 
  3. More on Speaking Up  – this post
  4. Shock
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5 thoughts on “more on speaking up

  1. Warmsocks, I was glad to see you be so forthright about some negative experiences with doctors. However, like so many books authored by doctors you backtrack to cover your tracks so as not to be disrespectful. Doctors who confess about treating patients less than optimally (anonymously)tend to give excuses for their actions — sort of a non-apology.

    I can’t even count how many times doctors were rude to me to cover the fact that they were out of their element. This is not a rare occurrence not only based on my personal experiences but also those of many others who shared in blogs and books and studies on bedside manners.

    You bring up a very real problem that is affecting the healthcare of many persons because healthcare has largely become a business about making money like Goldman Sachs and GM rather than a business about delivering a service.

    Just to give you an example of what I am referencing is one colon surgeon who blamed my chronic constipation on my beginning to take Tramadol when it turns out I had an intussception in my colon that was causing a blockage. He ended up referring me to a urogynecologist because he misinterpreted the MRI report reference to rectal prolapse (an internal rectal intussception) to mean uterine prolapse. I eventually found a knowledgeable colon surgeon at The Cleveland Clinic (8 hours drive away) and got the operation I needed. But it took me six years during which time I became disabled and qualified for Medicare before I had insurance that would cover me out of area.

    I live outside of Washington, DC, our nation’s capital.

    At the Cleveland Clinic I was on a floor full of patients that had colon surgeries. Some shared similar nightmare stories about their encounters with doctors.

    I don’t think bloggers should just lambast all doctors for the idiotic actions of many. But I feel your commentary reflects your good fortune in finding doctors who would listen to you before you encountered a major health catastrophe. Many people aren’t that lucky. This is a real healthcare threat that needs to be brought to the forefront before more people suffer needless medical mistakes. And for me, your statement that this rarely happens and all one has to do is speak up or change doctors makes light of a serious problem. Just my thoughts.-Doctorblue

  2. None of us likes to be treated disrespectfully or like children by our doctors, but it’s absolutely true that some doctors make it very hard to speak up. Sometimes it’s the time factor; other times it’s the doc himself, who acts disinterested or cold.

    I’ve never clammed up with any of my doctors, but I have left their offices feeling belittled and furious. One PCP I had, in particular, really steamed me. I’d been going to him for more than two years, although I was an infrequent patient. I’d never actually seen him, though; it was always his NP (who was quite good, by the way). The day I finally DID see him, he threw himself into his chair in the exam room, my chart on his lap, and proceeded to stare at it. Once in a while he’d ask a question, his tone clipped and peremptory. He didn’t look at me. There were long stretches of uncomfortable silence. Finally, he leapt up, said he’d refer me to an allergist, and left. I was flabbergasted. And I was so insulted and angry that I fired him.

    My current PCP, a VA doc, is genial and helpful, for which I am grateful. She has never treated me with anything other than respect, though she is extremely busy. Your suggestion about writing down questions and talking points has helped me during appointments with her, as well as with my other doctors.

    In the end, I think we just have to take our healthcare into our own hands. Speaking up is paramount. Thanks for another excellent post.

  3. Pingback: Shock « ∞ itis

  4. (I posted this reply on Kevin, MD but for some reason it was moderated.)

    The first thing you can do to stop the blame game is stop internalizing the blaming mechanisms some physicians use. If a drug is causing you intolerable side effects you have every right to stop taking it. At all times you have a right to decide what you will and will not put in your own body…you’re the one who has to deal with the consequences if anything goes wrong. Never mind the nonsense about “noncompliance.” Your physician should focus on his own compliance with the standards of medicine, and creating fanciful psychosomatic explanations for medical problems without proper examination doesn’t cut it.

    As patients we need to recognize that sometimes doctors prescribe things just to shut us up or so they can say they are doing something for us. Other times, they may even be getting kickbacks from the drug companies for prescribing this or that drug. You absolutely must insist on the right to choose what you put in your body and be ready to leave any doctor who doesn’t respect this right.

    As for the doctor giving you the “it’s all in your head” speech, I would not waste a minute or a dime trying to reason with this doctor unless you’re stuck with him. You’re not going to give him the education he failed to get in 13 years of medical training so there is no point in trying. You have every right to “doctor shop” if the one you have isn’t doing the right thing by you. Once again, it is your health and life on the line, not his. Why this is a problem for some doctors is beyond me, but they tend to see it as evidence you’re either a drug-seeker or a “difficult patient” both of which can result in you being denied treatment.

  5. Pingback: Cross-Posting « ∞ itis

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