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