Saturday, February 25, 2012

We meet again, Dr. Nemesis

I have, quite obviously, spent a good deal of time interacting with various doctors. I've had great doctors.  I have had criminally incompetent doctors...  I have even had a grossly obese doctor who stomped out of the room angrily when I questioned a drug dose, given that that same drug dose had recently resulted in my getting bronchitis.

But the worst, the absolute worst doctors are the patronizing, arrogant, “Doctor/God Complex” doctors. These are the doctors who told me, in my freshman year of college when I lost 50% of my hair, that I was “just stressed.” These are the doctors who told me that the severe, unbearable chest pain I experienced was just due to a heavy backpack. These are the doctors who clearly thought I was a) neurotic, b) hypochondriac and c) just looking for attention. This despite the fact that my blood test results for the past eleven years have shown that something is seriously wrong with my body, and that autoimmune diseases clearly run in my family.

These doctors are scum. They take someone who is already terrified, confused, and in pain and totally dismiss it all as, “just stress.” (Other variations include, “just depression.”) These so-called physicians completely ignore anything for which they can't, don't know how, or simply won't bother to test. These physicians take patients who are suffering and do their level best to convince them (the patients) that they are crazy. Luckily, most doctors do not fall into this category. Unluckily, anybody with a chronic illness will run into many, many such gems of the medical profession.

My newest addition to the “first against the wall when the revolution comes” list is a neurologist. This neurologist, despite seeing me with a noticeable tremor, having had his colleagues see me shake uncontrollably in the ER for hours, despite having heard my newly acquired sometimes–severe stammer, and despite my having random muscle convulsions strong enough to wake me up every night, has decided that all of my neurologic symptoms are... you guessed it, “just stress.” Oh, except that he was kind enough to take the credit for discovering the carpal tunnel syndrome that was diagnosed about ten years ago.

 Stress, of course, can exacerbate most medical conditions, absolutely including lupus. But stress in and of itself is not a biologic mechanism. It has no receptors. It is not the direct cause of many symptoms. It doesn't explain why something's happening; so when a doctor uses it, it's normally because he doesn't want to say, “I haven't the faintest idea what's going on here.” And of course, it has the added benefit of blaming the whole thing on the patient, who really shouldn't be so stressed. This particular neurologist didn't even believe that lupus was enough of a stressor until I explained in short, simple, easy to understand words that lupus means that I am always in pain. Always. And that I have been in such constant pain for the past two years. If you really want a stress culprit, that sounds like a pretty damn good one to me.

I have a lot of doctors, many of which are very good, compassionate, and caring doctors. I appreciate them more than they will ever know,  partly because I have met so many of the other type of physician. But nothing makes me angrier than the “other type" of physician, because of the irreversible damage they do. They damage patients' self-esteem, their belief in their ability to judge their own bodies, and the likelihood of patients seeking out non-jerk physicians. Patients who have dealt with the "other type" of physician sometimes even put their lives at risk rather than risk another such unpleasant encounter.

 I've come pretty close to the end of my ability to describe how I feel about the “other type” of physician without reverting to the kind of language I generally try to avoid. But the take-home lesson from a relatively experienced and highly educated patient to any newer patients is simple: if you come across such physicians, run! Run away and find someone competent! Do not put yourself in the position that so many of us were stuck in for years, during which we became half convinced that maybe we really were just crazy. If you're sick and hurting, you're sick and hurting. Any so-called physician who tells you otherwise is not someone worth your time. That is, of course, not to say that any physician who suggests antidepressants or mental health care in addition to other treatments is  a bad doctor. But anyone who belittles you or your experiences, or who blames everything on "stress," “depression,” “overwork,” etc. is not someone you need in your life.

  And to the physicians who are not arrogant, who do listen, and who often go far, far beyond the pale trying to help us... well, all I can say is God bless you, every one of you. You are the ones who save lives. You are the ones who recognize and acknowledge genuine illness and pain. You give patients the honor of being treated like human beings, and again, may God bless you for it.

Image credit #1: from Devil's Panties, Oct 2005. This is a web-comic, btw, not some kind of porn site, despite the name. It is not, however always a family friendly web-comic, but I love this image!
Image Credit #2: A copy of the beginning of the Hippocratic oath, by which all physicians are supposed to regard as guiding principals.


  1. I had an "other type" dismiss my Crohn's as nothing but "a little irritable bowel" not before but AFTER it had brought me to the brink of death in the hospital--and I knew he knew it, because at the time he had commented on how glad he was that I'd survived it.

    Then he dismissed at least 15 years of lupus diagnosis and six of Crohn's and said it was all in my head.

    Wait. WHAT?! Yup, all labs were false positives.

    It was doctor-speak for "Go away. You make me feel too mortal and I am not comfortable with that."

    Never went back.

  2. Yes, these people are in practice - I had one 'young one' (less than polite Irish expression :)) tell me that I could not be having the side effects of a drug that I was describing because 'it was not a therapeutic dose'. Any medication at all going into your body has potential to do damage, and different people need different amounts. A singe chocolate has me down with migraine, most people would not consider that a 'theraputic dose' :)

    I have had your reaction to a good few medical professionals in my time, the only solution is to not go back to them. There are some excellent people out there too

    No, stress is not going to give you lupus, but as you say yourself, it does not improve your symptoms. You say you are very angry, and rightly so, but you know you are damaging yourself with that anger. Write it down, keep a note, then let it go. Your being angry is not going to change the situation, and it will not do you any good.

    Smell the coffee, enjoy the flowers, relax. I am not being patronising, honestly, but believe me, getting mad about things that your anger will not change will not help your health. Oh dear, here endeth the first lesson!! Loving thoughts go to you from me. I don't know if you recognise my name, we have met, I am Helen's mum in Ireland.

    1. To tell you the truth, I recognized you at "young one." It's an expression I've often heard Helen say...on a nearly daily basis, come to think of it. The joys of TAing...

      I agree that it's not good to let these things fester. And I think I'm normally pretty good about letting things least, until the next "other type" of physician makes me angry all over again. But writing this post was my way of letting off steam, as well as telling other patients that they are a) not alone and b) should not allow themselves to be belittled by a doctor.

      I hope you enjoyed having Helen back with you. We missed her while she was out there.

  3. Could not have said it any better Sam. I was diagnosed with depression for the past 30 years and no one ever took me seriously about the pain, fevers, sores, etc. I cannot believe that it took one silly blood test that no one ever bothered to run to find out what was happening. I lost many years, friends, and money to this disease. I have also lost my self confidence. When you have the symptons but no one listens, you tend to question your self and your own sanity. I am not depressed, I am sick!

    1. Get this: the first time I had the ANA test run, it was only after I made the dermatologist who called the hair loss "just stress" order it. It came back positive...and so I never heard from him again. Nothing. I had to call the nurse to get the result. I guess he was so angry about being proved wrong that it was more important to keep his ego in tact than to, I don't know, maybe refer me to a rheumatologist?

      I'm so sorry it took 30 years+ in your case. THat's unconsciounable. I was "lucky" because my mother has lupus, so they took that into account and gave me the diagnosis earlier than they would've done otherwise. It still took a little while, but it wasn't nearly as bad as in your case.

      I make it a little difficult, because I *am* clinically depressed (if I don't take my meds, which I do). However, since I take anti-depressants and go to therapy like a good compliant patient most of the time I avoid getting told that's the only thing going on. But, as this post shows, not always.

  4. The first two of my five children were delivered by men . . . who inadvertently illustrated some of your points. "No, no, it doesn't feel like that." Or "No, I'm sorry it's hurting so much now, but you've still got a few more hours." (Nurse screams "I see hair.")

    Another case in point. My father in law's Dr. told him he would die of the congestive heart failure the Dr. had just 'discovered.' (It was discovered by the draft board two weeks after Pearl Harbor. They rejected him. So the heart problem probably prolonged his life by 60 years.) So ten years later, when he dies at home of what looks like delayed stroke symptons (according to Dr. Son in law) the Dr. who never actually saw him, writes "congestive heart failure" on the death certificate. That Dr. just HAD to be right.

    And while I'm at it, I should explain my relation to you. When I was in high school, my cousin Boyd married your Aunt Carolyn. Then, when I was in college, my roommate's cousin married your mom. So your mom and I are cousins-in-law. Perhaps that makes me your in-law once removed?

    1. In the Hyde clan, we shorten all such relationships to "cousin." So, nice to meet you, cousin!

      I have taught pre-meds, and medical students. Those experiences taught me why doctors are they way they are, and why I should trust my own body, as opposed to what they say my body is doing. Some doctors are great...but an awful lot are arrogant jerks who hide their mistakes, pester TAs for extra (undeserved) points in order to get into med school in the first place...etc.