Just back from the doctor and was left with all this:
SHAME for not coming in for age and time-recommended pap smear or colonoscopy
RAGE for not being heard when what I was saying was so simple
RELIEF and JOY for speaking up for myself and being assertive
PASSION for a system of health care that includes curiosity.
The first question the practitioner asked was whether or not I consented to the AI companion, who would take notes. I did consent, but reluctantly. In hindsight, I wonder if the patient is privy to the notes, and if so, in what capacity? Perhaps objective documentation would help me process what happened next.
We sat down, and she went through a quick check-in where she reminded me that I already had a thyroid test in November, right after I said that I knew my test had been normal, but I wanted to dig down a little further because of some hypothyroid-like symptoms.
That's when we discussed the other tests as being overdue, which they were, but was that important? I asked if they were.
“Are there similarities between those diseases and what I'm describing?” I asked her twice.
She only half answered.
Then she asked questions about my diet, which were most likely relevant, and also reminded me of calling the tech hotline and hearing someone ask me to unplug my modem.
OK, SO I NEED MORE FIBER! WHO DOESN'T?!
As I described a recent diagnosis, on my way over to the exam table, the doctor truly tried to shut me up, even though what I was describing had to do with why I was there. Electively. I decided to spend the morning at One Medical - they should thank me for that!!! Anyway, as I was saying, I was curious about the relationship between a recent diagnosis and other health symptoms I had already explained. The doctor said she would have to look at my chart to comment on that diagnosis.
I felt confused.
“But I'm telling you now, what's in my chart. That's what I'm saying.”
She put up the wall. She said the same thing. I asked her why she wasn't listening.
"I HEAR you," she said - but she didn't. Maybe she heard me, like, she heard words were coming out of my mouth. But she didn't understand them. She just put me off. How to describe letting someone you don't know touch your body when they've just put you off…
Doesn't everyone who goes to the doctor for something specific feel slightly overwhelmed by not knowing what to ask and a bit chatty about all the potential dots they've been trying to connect? Was I too much? Does this not sound familiar?
“So, hang on,” I said when she repeated herself, “there's a disconnect. You're saying you need to look at my chart for a comprehensive view of my health, and I'm giving you a comprehensive view, and you're saying you need to get back to me.”
“It's ok,” I said, “if you just don't know about the diagnosis I'm describing and you’re saying you need time to review, but I’m trying to tell you that's what I have.”
“I believe you,” she said. “I'm just saying, I just met you,” (gesturing at the clock) “and I need to look at your chart.”
I gave up. We did the physical exam. I got the lab tests. Then I left.
When I got home, she emailed me her reading of the biopsy results I'd had in November and her reiteration of what I had told her, which was that they didn't entitle me to a referral to an endocrinologist. She said, I hope this helps.
No, writing me back the same information that I had specifically told her in person didn't help me with anything.
The linguistic issues between patient and caregiver are mystifying to me. Why can't we see that a problem in medicine is that there's no "we" for what "we're" talking about? There's just an I (the patient) and an I (the doctor) who are always at odds. Then the patient has to do unpaid labor for the doctor, including traditional trapping of not offending someone with a predetermined authority.
Is there no training for understanding you're not above your patient, but at the same level? Do you never have to consider that your patient might have the answer and it's up to you to put the medical words on it, but not to find some other answer to a question we are not asking? Are you always skeptical that the patient hasn’t already done what they've needed to do?
What am I missing here? Is there some medical liability in which, if a patient tells you something, you responsibly follow up by co-opting their statement as something you've already told them? What is the dynamic at play here, and why is it played? Who does this help, and why does it continue? What exactly is needed to bridge this gap for good?
The thyroid panel will likely be fine. Then I'll go back to asking my phone to remind me to drink some more water.
Today was just my little rebellion. I want a big one.
In my dream world, we would all have high-level health practitioners trained in listening and discerning what WE are saying, not what they hope they will hear: that the problem is simple, that it can be solved with some numbers, and that if the numbers don't tell a story, the default one exists: patient A has not B'd their C's, and they need to go home, and D, do them.
Instead, practitioners would see our patients as part of the puzzle they are trying to solve about the well-being of all people, our systemic harms, and our honest solutions. All visits would be seen as a chance to gather critical information toward vastly improving our culture of care. And doctors would not have to choose between valuing their expertise and treating their patients with integrity.