Tuesday, January 25, 2011

Hey Doc....you wanna stop taking notes and maybe ask some questions?

I met my new "primary care physician" today. I put that term in quotes because while that is, indeed, the official title, actions speak louder than words.

I made a doctors appointment last week, for a persistant cough. I had some concerns, most notably that I wanted to make sure that my very aggressive form of endometriosis had not migrated to my lung. This is not crazy talk - my endo has traveled from my diaphragm down through my hips and into (theoretically - they haven't one surgery to confirm it) my left leg. It is unusual to have endo in your lung, but my case is an unusual one, in that my endo has spread far beyond my reproductive system. Bowel, intestine, diaphragm, ovaries, rectum, bladder, it has spread through my abdomen like silly string. But so far, it has never gone above my diaphragm, that I know of. And I didn't ever worry about it, until I developed this cough. And this shortness of breath. I have been tired and run down for......months, I guess. And I have been coughing for over a month.

I know colds can linger...but this feels different. And I just needed the peace of mind. In the past, my suspicions have almost always been proven right, even as a child I always knew I was getting strep a day before the spots showed up on my throat. So I wanted to see my doctor, and explain my concerns, and rule out the other possibilities before I really started to worry about endo.

But my doctor - my regular doctor - had moved away, and been replaced with this...........well, this other guy.

I don't know how you feel about going to the doctor, but I know I feel a lot better when I know and trust the person who will be examining and treating me. So in seeing someone for the first time, I was already anxious. And then the doctor came in, and it got worse almost instantly.

Listen. I know that every doctor does not have time to review every patient's medical history. That said, I think it is important for a doctor to walk in, shake hands, make some eye contact, introduce themselves, and say "So, tell me what's going on." I have received that courtesy in emergency rooms and with countless other physicians. Being allowed to explain, and perhaps give some background information that might help in finding the most effective treatment, puts me at ease. I have a complicated medical history to be sure, and there are a few details that really are important. Like, for inst-
"So you have a cough" he announced in the open doorway. The nurses in the hall glanced away, trying to offer me a bit of privacy.
"Yes, since Christmas."
"Are you pregnant." he said as he washed his hands. One of the nurses closed the door quietly.
"No, I -"
"How do you know for sure?"
"Well, I had a hysterectomy."
"Why would you have a hysterectomy at your age?"
You would think that by asking me a question, he would actually give a shit. But he totally didn't.
"I went through menopause. I was diagnosed with endometriosis when I was-"
But now he was examining me. No comment, no "I am going to put my hand under your shirt and listen to your breathing", no kindness or conversation or empathy. "Take a deep breath." The exam was over after 4 deep breaths, and he was back to his keyboard. There was minimal eye contact as he typed away.
"Any history of asthma or allergies?"
"No, not reall-"
"Do you smoke?"
"Rarely. I-"
"Only two answers to that question - yes or no. It's like being pregnant."
"Okay, well I-"
"How about heartburn. Indigiestion? Any of that?"
"Well it says here that 3 years ago you were treated for some-"
"I believe it was related to my endometriosis. It wasn't reflux. Or indigiestion. Or heartburn." And, for the record, I think it was more like 4 or 5 years ago
He was typing away on the keyboard. What was he typing? He had only asked me, like, 3 questions, and as far as he was concerned there were one-word answers to everything.
"I'm sending you for a chest x-ray."
"Okay." I was defeated, and realized that he was going to leave without my having the chance to ask him any questions.
"And I'm giving you an inhaler. You have a bit of wheezing in your cough."
"But I-" I don't have asthma. I don't. And I have all but quit smoking. Two cigarettes in the last 6 weeks - both smoked at work during a moment of extreme stress. Which was something I needed to talk to him about. My stress. I wanted to ask him about my neck and jaw pain from clenching my teeth all the time, the migraines, and the panic attacks that have been creeping slowly back over the past few weeks.
"I'll be right back."

And it was over. He walked in and handed me a piece of paper, turned on his heel and walked back out the door, pointing me towards the exit with one hand as he walked away down the hall.

So I had my chest x-ray, and took my inhaler, and went home. Still coughing. The inhaler didn't help.

And once home, I got an email:

He got the results of the x-ray. Which showed a possible something in my lung. Which needs to be rechecked in 4-6 weeks. It could be anything. It could be nothing. It could be a spot on the piece of film they used. It could be a shadow.

It deserved a phone call. There wasn't even a way to reply to the email.

So here's the point of my post. We deserve better. If you have a doctor who doesn't give a shit, then please, I am begging you - find one who does. You know more about your body than ANY DOCTOR. You know when you aren't feeling well. You know your medical history. You are your advocate - and your children's advocate, and your spouse's advocate, and your parent's advocate.

I am not saying this to encourage everyone to second guess their doctors or monopolize the appointment for 15 minutes discussing the vitamins you are taking and what your sister says is wrong with you.

But your doctor should ask you some questions. Especially the first time you meet them. Your doctor should spend more time talking with you then typing on his computer. Your doctor should listen to you, just as you should listen to your doctor. And as always, you should listen to that little voice in the back of your head.

My little voice is shopping around for a new primary care physician.

1 comment:

STATJR said...

Your are ABSOLUTELY correct! I became a paraplegic at age 14 because of a doctor that didn't give a shit. I have fought the related medical problems since. I have been though numerous docs and have told many of them where to stick their stethoscope.

I now have a very nice doctor who listens and cares! My suggestion, look for a FEMALE doc. I am a male and I love my female doc. Some men don't feel comfortable dealing with a female doc, especially if they need to talk about reproductive issues... I have no problem. She has seen, and well, "been with" the same parts I've got (not mine of course) so she knows about that too!

I find that female docs listen more, show more compassion and generally take more time with each patient!