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Loading ...I winced a little when I saw his name on my schedule. The visits were never easy – there were usually a myriad of problems to deal with, none of which seemed related. I knew that anxiety was at the root of things, and he was actually seeing a counselor and getting medications for that anxiety – yet the problems never seemed to get better. The visits never seemed to get shorter.
I walked in to another set of problems. The review of systems sheet was marked up with over half the symptoms being positive. My stomach sank as he didn’t make eye contact when I greeted him. This will be a long visit, I thought, with an inward sigh.
He had recently been to the emergency room with breathing problems and was told that “nothing was wrong.” He stared at his feet and fought tears as he said this. “They never believe me,” he told me. “My last doctor told me she didn’t want to see me any more because he didn’t want to listen to me complain.”
I winced. My job is to listen to people complain. The reason that patients come to my office is called the “chief complaint.” When I say “how are you doing?” I am not just being polite, I really want to know. How could physicians be so cruel, I thought.
I asked him how he was feeling.
“Terrible. I still can’t breath, my head hurts, and I am going to a funeral tomorrow.”
“A funeral?”
“My grandfather died in his sleep. They still don’t know what happened, but he was really healthy.” The battle to hold back the tears was failing, and teardrops speckled his pants. I handed him a tissue and he hid his face in it and sobbed.
In the end, I ordered some labwork and gave some medication that might help with symptoms. I suspected that the majority of the symptoms were related to anxiety, and when I suggested that this was part of the problem he agreed wholeheartedly. “I know I am real anxious. I just can’t help it. It doesn’t help when nobody seems to listen to me. I just want to feel better.”
My lack of outward judgment seemed to make him feel better. He thanked me for listening. My inner attitude, however, was ringing in my ears. I had walked in with judgment and impatience. My contempt for the previous physician seemed hypocritical – I was dreading this “complainer” just like she had. I was ready to hurry the visit so I wouldn’t get caught up in the anxiety. But there were facts I didn’t know. There were reasons I didn’t imagine.
First do no harm.
Sometimes harm doesn’t happen by incompetence or neglect; but instead comes from an internal deficiency: a deficiency of empathy. The visit is about them, not us.
Thanks for the reminder.
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Good post, we had a PA who I think used to feel the same way about us. I enjoy your blog.
I wonder if unrelieved anxiety falls in the same category as depression, and is a side affect of a larger problem. See my post on depression on Robin’s blog “Herding Zebras.”
I’m going (very publicly!) out on a limb here – with the anxiety that never gets better, headaches, trouble breathing, etc., what’s the chance he has an endocrine problem. Having two children and a husband with Cushing’s has my radar on alert all the time.
I have generalized anxiety disorder, phobias, panic disorder, etc. This started when I was 11 years old. I went to doctors all of the time because I always thought I was dying of something. Not one ever suggested that I might have a problem with anxiety, and not one ever referred me to a psychiatrist or therapist. So until I was 40 years old I was living a horrible life, fighting every day to get through the day, waking up every night unable to breathe with my heart racing. My 10 year old son was having some of the same issues, so I took him to a therapist who referred him to a psychiatrist and he began taking an SSRI. When I saw the change in him, I took myself to a psychiatrist and began taking an SSRI. My life changed in ways I never believed possible. I know I can never get those first 40 years back, and the anxiety and phobias have had long lasting effects on my self esteem and my feelings of self worth. I wish I had had a doctor like you somewhere along the way. Please try not to let any of your patients end up like me. Thank you.
Judy: Very unlikely endo problem. Bottom line is that anxiety is ubiquitous. Society is rife with it now. Anxiety and depression are heads of the same dragon – both are emotions that don’t know how to act and so come out at the wrong place/time. Anxiety is a feeling of helplessness, depression is hopelessness. The emotion of anxiety is normal, but we are all pressed by expectations – society is very much under the thumb of anxiety. I observe it in the exam room constantly.
Again with the Psychoactive Drugs, Dude just needs to get laid.
Yikes! I can empathize with the guy. I have severe anxiety and depression and it often bubbles up as physical symptoms. However, I am usually the one that starts a visit with “It is probably just anxiety, but….”
I actually had/have chest pain alot. I would have to make an appointment…and tell the receptionist not to freak out….so she wouldn’t feel like I needed to be-seen-right-now!! I actually worried that I had an ulcer. anyways, Diagnosed with GERD. Once my doc pushed on my sternum (it hurt like heck!) and realized my chest muscles got all tense when I was anxious.
Anyways, I was having lots of issues with swallowing and the GERD. I had to get a barium swallow. They told me I had “spasms”
Um….big cause of chest pain.
Anyways, I know alot of my ’symptoms’ are anxiety. And it is awful cause you have ‘real” symptoms that could be something ‘real” and bad. And then you worry, and they get worse! I have asthma too, so that is also a lovely disease that can get worse when your are worried that you are having an asthma attack.
I sometimes wonder how my doctor puts up with me.
Having a mental illness can suck.
Great post. Thanks for being the antidote to the cynical venting/ranting that is so rampant in the med blog world.
Judy’s post she was talking about is at <a href=http://herdingzebras.blogspot.com which is a blog that is written by multiple authors, including Judy. It’s not “my” blog. Rob, I think you’ll find her post interesting. I’m not advertising and you are welcome to wipe this if it looks that way.
Secondly, thank you for a refreshing post. I know my PCP winces when I call. She’s honest about it. And it’s not so much that she dreads me coming in (at least that’s what she says) but that I’m never a straight-forward case. I welcome her bluntness and honesty. She isn’t perfect, but I do know she cares. And she hugs me. Now, that’s medicine that is priceless.
So, Dr. Rob…you are good medicine when you treat patients like you treated this fellow. And your brutal honesty about yourself and your inner thoughts reveals an effort to make a difference with your patients. That’s what counts. Thank you.
Robin, I know exactly what you mean when you write that your doc winces when you call as you’re never a straight-forward case as my son and I are the same way. We have coined it the “1% factor” because with my family if there is only a 1% chance on something happening then it will happen to us. Most people think I am just being humorous when I tell them about the 1% until they get to know my husband, son, and I better….lol The sad truth is the 1% does not only affect us medically but in most all aspects of life, but we have accepted this with all the humor that we can muster….if we didn’t we’d be too depressed to survive it.
The hubby and I were actually thinking about getting 1% tattoos until we learned that a 1% tattoo is a Motorcycle club/gang tat meaning that the person with the tat belongs to the 1% of Bikers live a criminal lifestyle…at least we avoided that problem..lol
I totally agree with Dr. Rob being someone who practices good medicine and treats his patients very well…in fact I am very envious of his patients as I have yet to find a physician that comes close to his demeanor.
And To Dr. Rob…Please do not beat yourself up over experiencing a feeling of apathy at the time of this patients visit….you were not cruel to him, or planning on being such…..you are also not infallible…we all experience a wide array of emotions when dealing with patients/people. The more important issue here is that you recovered yourself quickly enough to help your patient, and you learned from the experience which is all we as humans can offer.
~Judi
Good post,
and a reminder that, sometimes, a little time spent, empathy and reassurance go a long way.
My apologies Rob, for assuming you gave him an SSRI or NERI, or whatever RI the Drug Reps are pushing this month, you just said “Medication”….aren’t those Cialis Samples Great!!!!!????
I hope your attitude will rub off on lots and lots of doctors out there. I guess I am one of those patients my PCP hates to see coming. We KNOW how difficult we are too. We KNOW the anxiety causes physical symptoms.
That is one of the most frustrating things about mental illness to me…to KNOW all this and still not be able to control it or make it go away.
When you get aggravated by a difficult patient and wonder why you’re in the profession you’re in, remember the fact that you will probably never know how many people you touched in ways that will last a life time.
I WAS the biggest hypochondriac, and I cannot express how dreadfully embarrassed I was when I finally figured it out. It wasn’t that no one had ever suggested it might be related to anxiety – I just refused to believe it because my symptoms were so real to me. Although delusional, I was completely sincere. The fact that my doc never lost patience with me through all of my theatrics meant a lot to me and made a real difference when I was so fixated on my health; had he treated me otherwise, my life may have turned out differently.
I’m in PA school now, and although I know from my own experience what it’s like to BE that patient who is in the clinic all the time, calling all the time, taking a gazillion unnecessary medications, and getting multiple million-dollar workups, I still fear that my patience may eventually wear thin when I’m dealing with as difficult a case as I once was. Thankfully, examples like you and my old doc give me hope that it is possible to keep things in perspective… and to treat the PERSON, no matter how annoying he or she can be.
Thanks for sharing this.
Christine:
Your experience will do much for your ability to relate to patients. You know how they feel – awkward and self-conscious, most of the time – so you will be able to meet their needs better. Many providers have no idea how hard it is to sit in the place of the patient.
All I can say about this post is – Thank You.
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