29 March 2007

the difficulties of being the patient in the doctor-patient relationship

a few days ago, i had what i thought was a good idea. i thought that, after all that i'd been through recently, it would probably be a good idea for me to go see mr_dr_do and see if we could come up with a plan for my healthcare that would maximize the possibility of me being at least somewhat healthy by the time i return to school in august. what was not a good idea: scheduling this appointment for the day after i'd gone *splat.*

i started getting anxious about the appointment last night. that was my first indication that something was wrong. i tried to think about it--why am i feeling anxious? but i really couldn't put my finger on a precise cause. i thought some of it had to do with my embarrassment over having to leave school, another part to do with the fact that i was feeling just emotionally vulnerable enough that i was afraid i would cry (why it bothers me to cry in front of doctors, i really don't know--but it really bothers me), and some to do with the fact that, ever since i was a little, little kid and experienced some GI problems, i have absolutely detested talking about my bathroom habits. to anyone. you can tell me all about yours, just don't ask me about mine. it's an odd quirk for a doctor-to-be, but at least i know where my quirks lie.

needless to say, i didn't get much sleep last night. this was okay, because i was reading a really good book (the sunday list of dreams, by kris radish) and relishing it because it's been so long since i've had a chance to read a non-science text. but it also meant that i was tired today--more tired than usual--which just means that i was all the more vulnerable by the time i arrived for my appointment. this was not a good thing.

mr_dr_do's office is quite nice. it's the only primary care office i've ever been in where i didn't feel like i was one cow in a herd of cattle. everything is simple, efficient, and, aside from the argument i'd probably get from the lady who answers the phone over this one, it's actually quiet. this is a relief for me, as i hate being stuck in waiting rooms that feel like airport gate areas, with tv's blaring, tons of general noise, and, invariably, carpet patterns that make me dizzy. so, again, when i go to mr_dr_do's office, i really have nothing to be anxious about: i'm not overwhelmed by his office and i like having him as my doctor. but today, i was anxious.

it didn't help that the assistant who retrieved me from the waiting room was not in a good mood. and here's where i run into something i don't understand about certain medical offices: what is the deal with the assistants? she took my vitals (grudgingly), then asked me why i was here to see the doctor today. now, i get that one of the most important parts of the medical record is the chief complaint (cc for short), but seldom do i feel like talking to these people, given that the physician always proceeds to enter the room and ask me the same damn set of questions. what's the point? i really, really don't know. so...i was hoping (i must be delusional) that by giving this chick (<--i don't ordinarily use this term, but anyone who dyes their hair with blond streaks and has funny patterns on fake manicured nails fits the description too well for me not to use it) my letter of withdrawal from school, i (a) wouldn't have to talk to her for much longer, and (b) between that and my cc, should've been enough information to give the doctor a clue as to why i'd appeared for this appointment. i'm not sure, though, that she actually wrote anything down. the chick soon disappeared, and i was left alone to indulge in my book. here is where the experience begins to get even more problematic. the book itself is basically about a mom who finds out that her estranged daughter has opened an adult toy store in ny to provide women with options for obtaining and maintaining sexual health. so the part i was reading was describing one of the new employee's feelings about his first day on the job. he was astounded by the number of women who came in--particularly about their ages and the fact that so many were not sexually satisfied. i went to a women's college for my undergraduate degree, so i'm pretty opinionated about this subject. i didn't start off at this college, but rather at a catholic institution, at which they didn't even sell condoms on campus (in spite of the fact that 80% of the student body was engaging in random hook-ups every weekend). i transferred out of there after my first year and entered a totally different universe. i learned that women who are educated talk about things like birth control, masturbation, toys, fetishes, body-types, etc. you couldn't go to this school without learning about these things, and, i think, by the time most women graduate, they're pretty damn liberal about this stuff. (yes, even the republican women.) so, i was getting a little homesick as i was reading this book. i miss being in a place where sexuality is celebrated instead of suppressed. and i feel odd about the fact that i've landed in a medical school where they're still rather, well, in the dark about some of these things. it bugs me, in particular, because i want to encourage women to be more in touch with their bodies and know that liking sex doesn't make you a slut. not to mention that it is a woman's right to have an orgasm. but that's just my opinion....

anyway, it was an odd thing to be reading/feeling when the doctor walked in the door. i was relieved that he didn't have the hot 3rd year med student with him this time--i don't think i could have tolerated being outnumbered by that much testosterone/eye candy just then. it was also one of those times when i felt oddly ambivalent about seeing a male doctor. and this is something i still don't understand. most of my doctors are male. my main specialist in my hometown, who has handled the majority of my healthcare up until now, is male. he's seen it all, so to speak, and i don't have any problem with that. but i was struck, when i saw mrs_dr_do the week before, at the different type of energy she brought to the patient encounter. there was something comforting about knowing she's experienced being a woman and knows what it feels like to be in this type of body, and somehow that was expressed in the way she touched me. not to mention she didn't make a big fuss over things like listening to my heart under my shirt like physicians are supposed to do. nothing makes me quite so frustrated as knowing that a physician is taking a shortcut because he's too embarrassed to put the stethoscope under my shirt. i had a surgeon do that recently, before surgery, and i was stunned. there was an assistant in the room--it wasn't like i was going to claim being molested or something. but there's the rub--in today's pc, litigious society, doctors are coerced into taking shortcuts during exams. it's not only nuts, but it has the unfortunate effect causing me to dislike my breasts even more--they're always in the way. i know, intellectually, i "shouldn't" feel this way, but sometimes i feel like it's just another thing that makes an excuse for discrimination. then again, maybe this anger i have is more about the fact that i haven't had anyone around to enjoy them in a long time. did i mention that i miss having a boyfriend? <--odd thing for a feminist to say, isn't it? but i digress.

it was pretty clear to me, from the outset of this appointment, that i was not well-prepared to be there. one of the most profound difficulties i have as a patient is knowing how much information to provide a physician with, and how detailed i should be. it seems that i either haven't been paying enough attention (how often have you been taking x for your nausea? i dunno....), which frustrates the doctor, or i've been paying too much attention (here's the list of everything i've taken, experienced, etc), and get that you-must-have-ocd look. where's the balance? i still don't know. and i'm supposed to be on the professional side of this spectrum now. ha! as if that makes a difference! so, i wasn't prepared. and given the fact that the past ten days have been like a roller-coaster, i didn't know how to answer his questions. i felt myself starting to get frustrated, which wasn't a good thing, because i was already worried that i was going to burst into tears. which brings me to another difficulty of being a patient--communication. mr_dr_do said "i heard you were feeling better," and i looked at him, completely puzzled. "my wife told me," he pointed out. i didn't realize until later, after the appointment, that what i'd said to mrs_dr_do is that i'd been feeling better up until the time i landed in the er with the severe pain, but somehow that came across as i was better in general. given that i was (am?) still a bit freaked by that episode of pain, i don't know what to say about this.

and here we have another point: my desire to please people. especially with my male doctors, who seem to be more goal-oriented, i can see that they really, really, really want to hear that i'm feeling better. and i understand that, because i really, really, really want to stop feeling like crap. but i don't know what to say when everything remains uncertain. am i glad i'm only taking 1 of the nausea pills a day versus 3? yes. but it still sucks to be nauseated and i hate the fact that i have to take the medication at all. mr_dr_do caught this ("are you taking fewer because you're feeling better or because you're tired of taking them?" my answer: "both."), and that's one of the things i like about him--he picks up on such subtleties, unlike most PCPs I've encountered who may have been equally astute (I'm not entirely sure), but certainly never took the time to listen to me long enough to catch these nuances. And these are important nuances in the life of a patient. believe me.

but i so badly wanted to be able to tell him that i was feeling better that it hurt me not to be able to do so. i always end up in the doctor's office thinking, "please, please don't hate me for being a complicated case." sometimes i even go so far as to withhold information that i want to discuss with the doctor because it's clear that s/he is getting frustrated with me. the problem with this perspective, as well, is that i often run into another problem, the one i call the fascinoma syndrome. this is when my symptoms/disease process becomes so interesting to the doctor that s/he gets so caught up in my case as to forget that I'm a human with a life and not a lab rat. *sigh* i cannot even begin to describe the complications that arise from that type of doctor-patient encounter.

the odd part about today's encounter is that it took mr_dr_do a while to realize that part of the reason i was there is that i'd left school because of the medical problems and my anxiety about them. i did end up sharing some of my concerns about all this, but i don't think i was quite clear about how i felt. then again, what the hell does my emotional state have to do with my gut? everything. and nothing.

the other odd thing about being a patient is that for the patient, each encounter with the doctor is significant. i get almost hyper vigilant when i see a physician, in that i find myself latching on to their words and expressions so that i can sort out what happened later, when i'm less overwhelmed. this means that i'm a lot more aware of the encounter than usual; whereas, for them, I'm one of a steady stream of patients they've seen that day, barely distinguishable from the rest. So, i was a little surprised that mr_dr_do thought that i was younger than i am (this also made me a tad insecure: do i seem that immature when i'm here? is it my anxiety that makes me seem young? note that i think these things instead of, hmm...might it be that i don't look like i'm almost 30? why can't i think of the positive possibilities first?!?!?), that he'd forgotten i was an english major in college, and that he hadn't realized that i'm not one of the students who has come to medical school straight from college. he seemed a bit surprised to learn that i've had a long work history in healthcare, particularly in management. too bad i didn't get to tell him some of the crazy stories about managing odd groups of super intelligent doctors with not-so-great personal skills. those stories are unforgettable.

so, what makes a patient unforgettable? and why do we, as patients, care so much about what the doctor recalls about our personal lives? is it because the medicine impacts upon these lives? or are we merely making a mad cry for attention? or could it be both? i really don't know.

there was more to the encounter today--a lot more--but i won't ramble on about all the details. i think my point has been made. being a patient? it sucks. being the doctor? well, i guess i'll find that one out soon enough.

what i do know is that i left mr_dr_do's office today feeling out of sorts and confused. once again, i made it to the car before i started crying...but i'm not even sure why i cried. nothing bad had happened. i did get some help. so why did i feel so odd about the encounter?

maybe i'm just tired of being the difficult patient.

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a little disclaimer...

i'm a medical student. just a student. so please, don't take anything i say too seriously. remember that i was an english literature major as an undergrad, so there is much fiction to be found in these pages. do you think i'm telling a story about you or your illness? more likely, you're tapping into my sense of "everyman"--that is, your story resonates with what i write here because it's not so uncommon after all. need help? please, please go see your physician. <--i'm not her. yet. ;-)