fahye | following on from my last post

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following on from my last post

There's a question I'd like to pose to you all, and that question is this:

What do you want from your doctor?

I know a lot of people who have had bad experiences because they're queer, or overweight, or trans, or have a disability. I know a lot of people who have had bad experiences because they weren't listened to or weren't taken seriously, or because the doctor walked into the consultation with certain assumptions or communicated poorly with them.

I'm not really talking about the healthcare system as a whole, more about doctors as people and the one-on-one relationship they have with patients, both in primary care settings and in hospitals. I don't want to turn into the doctor people blog about because their experience was degrading or insulting or unhelpful or embarrassing. And as the daughter of a surgeon and a GP, someone who's never gone to a doctor herself except for basic things like stress somatisation and vaccinations (and even then, armed with a fairly thorough medical knowledge), and as a healthy white cissexual upper-middle-class person who's still struggling to recognise and own her privilege, I know I haven't had the same experiences that a lot of other people have.

I want to know what to look for when observing others in my profession for the remainder of my degreee. I want to know: what should I become? What shouldn't I become?

(Mental health is definitely included in this; it's a particular area of interest and concern of mine, and I think it's poorly understood and poorly approached by a lot of medical professionals.)

Feel free to link this post, if you like. The more opinions & anecdotes (good or bad) I get, the better.

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(caveat lector: I am also the child of a surgeon and GP, also upper-middle-class, also (mostly) healthy and well-informed, and also I grew up in hospitals so don't have any fear of the system.)

The best doctor of my acquaintance is in fact my GP, Dr L, who is chief GP at a very large, enormously diverse GP practice in east Oxford. I like Dr L because he's never not pleased to see me, and while he does deal with his patients efficiently he doesn't give the impression he can't wait to get rid of you. He listens patiently and doesn't interrupt, and lets me finish what I want to say (the worst GP of my acquaintance used to jump in, twist what I'd said to suit himself, had no respect for personal space, that sort of thing - I'm at a different practice now). I get the sense that he's weighing up in his head, how do I avoid confusing this person and how do I avoid talking down to this person, and he gets it right.

Also, he's friendly, even when dealing with mental health - another GP at the practice, the emergency one, makes me feel like my mental health is a personal failing (and not intentionally, I think; he has such a stern schoolteacherish manner that that's what comes across), and he treats depression like just another illness. Oh, and! Sorry, this is getting to be a really long comment, but the other thing he does is give me this sense that he knows what he's doing and everything else is under control. Yet another GP at the same practice always asks me, "What do you think?" and while I appreciate being asked that, not all the time, because I'm not the doctor I have no bloody idea. Sometimes, I s'pose, you want the doctor to say, confidently, here's what we'll do, are you okay with it, if you're not okay here's what else we can do.

Is that the sort of thing you were looking for?

That's exactly the type of thing I'm looking for! Thank you! Man, chief GP at an Oxford practice -- I want to grow up and steal Dr L's LIFE.

*grins* Oh, and, and, my parents' advice on How To Be A Good Doctor (I got a lot of these little talks before it became quite clear that medicine wasn't for me!) is just to know, and care about, everyone: say hello to the patients, the hospital cleaners, the phlebotomists, the nurses, everyone. I've seen him do it and it's astonishing how many people will do anything for either of my parents just because they remembered their names and asked after their kids and brought in baked goods. It doesn't take much to make people happy, I think.

This is very good advice! But be warned, as a woman you will, on average, have to be twice as nice as your male colleagues to get the same degree of warmth back from most nurses. I don't know why this is. I scoffed a bit when someone first told me, but in many places it's true. I quite consciously often do things that aren't my job (fetching a bedpan, drawing up and giving antibiotics spring to mind from the last week) in order to prove I'm 'not above it'. It's still worth it, but it can be frustrating.

Oh man. So, yeah.

On a basic level? I want my doctor to:

* LISTEN to what I say, and believe me. In my case, especially in regards to how drugs are affecting me - ie, I've been denied pain relief before because "panadol should be enough". Not everyone is a junkie.
* Not make assumptions about me or my lifestyle, but to ask instead.
* Give me all my options, even the ones they may not think suit.
* Trust me to be able to consent or not consent to things.
* Believe I am intelligent enough to understand my options.
* Do their damn research and be willing to admit when they are unsure or do not know things.
* Do their damn research and not assume that they learn everything in med school and then never have to learn anything ever again.
* Realize that just because something is rare, that just means it's rare, not that it doesn't exist. Occam's razor is great and all, but sometimes it bloody well is a zebra.
* Not insult me or my lifestyle. (You'd think that'd be obvious, but no.)

That's all I can think of at the moment.

Yeah, I know it's cropped up already, but the "respect of lifestyle choices" one is so important. Probably the most detrimental experience I've had with a doctor was when I was about thirteen or fourteen & my GP absolutely tore a strip off me for being a vegetarian, he said it was no wonder I was unwell because vegetarians are silly and unrealistic and he had no time for them. It was an unecessarily vitriolic reponse - especially since I was, you know, a child - and he pretty much refused to treat or deal with me after it.

I haven't had a whole lot of other GP experiences because that episode freaked me out about going for quite a long time & I avoided it where possible, but the GP I have in my uni city is just excellent - cares, listens, takes me seriously and so on. Mind you, I did practically have pneumonia by the time I went to see her, because I put off seeking treatment for my bronchitis for an insane amount of time due to The Fear, so it's a mixed bag all round really!

Long comment, ssssh me, but there is, for what it's worth, no doubt in my mind that you will make an excellent doctor. Just the fact that you give enough of a shit to ask is, you know, pretty indicative of that. so, yeah.

I've had repeated shitty experiences with GPs to the point where I avoid seeing the (perfectly good) doctor I have now even with things that are making my life difficult (the chest infection has finally cleared up on its own but I didn't NEED to have it for two and a half months). The foremost GP problem isn't something you're ever likely to fall down on as you're not an opportunist child-abuser.

Main problems have been:
# refusing to listen. I had a nightmarish woman called Dr Sleap as a teenager who persistently diagnoses me with gastrointeritis which I have (a) never had and (b) wasn't going in for anyway. I went to her with kidney problems, conjunctivitis, and a wart on my hand and was each time told I had gastrointeritis and thrush. I have no idea if she was actually mad or if she was so attached to pet diagnoses that nothing was going to come between her and prescribing a specific set of pills, but it was enormously frustrating.

# dismissing/patronising. This is a huge problem with mental health professionals, at least for me, who seem convinced that because you're *crazy* you must also be *stupid*, and that every previous diagnosis you've had (like three individual separate ones for Asperger's) must be overturned. Speaking with authority on a subject you plainly don't know as much about as the patient is just... bleh. Unhelpful. So often it feels like going to see anyone medical is a battle when it ought to be a cooperative move to get me well/better.

I think that's about the size of it. Being shouted at for being uncooperative when I was being autistic, being told flatly that I was wrong about my own sensations ("it can't possibly be hurting you" = well actually it was, because I was so freaked out about her insisting on a vaginal inspection out of nowhere that none of my muscles would relax), and being addressed like a criminal/liar/idiot a lot ...

Hope my whinging is helpful.

What I really want my doctor(s) to do is learn to read a computer screen. The NHS are spending vast sums of money on putting all of everyone's medical records onto computers, so I shouldn't have to repeat all of my complex and distressing medical history every. damn. time. I want a repeat of the same old medication that I've been on for years.

I also want them to be moderately scientific and not make assumptions just by looking at me (along the lines of 'you are a woman and therefore it's normal that you cry all the time' and 'you don't have massive visible rolls of fat therefore you are basically healthy'), and not to use the word 'exercise' when what they mean is 'activity'.

I can tell the anecdotes which relate to each of these examples if you like, but it might get long.

To ask this question. Oh my gosh.

I only see a cardiologist right now, I don't really have a GP. My cardiologist is a wonderful man, and he always asks lots of questions, listens to the answers and then asks follow-up questions. This is really important, and makes me feel like he is basing his treatment at least in part on how I actually feel and function, and not what the book says. One thing I would like to see is a better understanding of sexuality and sexual health in specialties--because hey, these things are actually related. For example: when I got my IUD, I found out six months later that it's not recommended for CHD patients because of the risk of endocarditis. My cardiologist didn't tell me, and neither did my gyno.

Also, stop asking about pregnancy! For the first six months I was at that clinic they asked me how I felt about pregnancy,telling me about the testing I would need, etc etc. Eventually I had them make a note in my chart not to ask me about it because it made me so cranky. Newsflash: Not every woman of childbearing age wants to have children, so don't act like we do.

I know these are really specific things, but what they point to is the tendency of specialists to get a bit tunnel vision-y. The thing the specialist treats has an effect on things other specialists treat, and on the whole patient as a person.

Off the top of my head, I would like:

a) For doctors not to lie to me/give an optimistic estimate of how much a vaccination will or will not hurt. "This won't hurt a bit" isn't very helpful when I hate vaccinations and they do hurt, even if the doctor/nurse/whoever is being gentle.

b) For doctors to stop telling me that the best way to destress and relax would be to compromise my uni marks. That would make me MORE stressed, because I would know that I could do better and wasn't. Even after I tell them this they just say that relaxing would be a good idea. The whole point about stress/anxiety issues is that you can't relax because of them! I got this from both my GP at home and the doctors at Uni Health Services, who probably see lots of stressed students and should know by now that 'just relaxing' or variations thereof are sort of ridiculous suggestions.

And another thing, which I just remembered.

My doctor at home, Dr. Michelle, has/had her kids at my high school and her eldest is a year older than me. I think her youngest was in my sister's year. Ever since Clancy (older kid) and I were at Mullum HS together, the second half of my appointments when my mum was present were not about me/my issues but about Clancy. I could not give less of a shit about Clancy, and my doctor's appointments are not a gossip session!

I would, admittedly, be more annoyed about it if my appointments with her weren't bulk-billed, because then I'd be paying for it, but when I make a doctor's appointment I think it's reasonable for me to expect it to be about my health, not about the doctor's kids.

On specific things I'm quite pleased about: I'm sure there's a note in my file at UHS now about how I absolutely can't stand tongue depressors, because ever since the first time I mentioned it, in first year, no one's tried them.

I've mostly had good experiences with doctors, mostly. Shocking one a couple of days ago where she'd made up her mind what was wrong before looking and ignored me crying in pain while she wiggled the damn thing in my ear, and on the strength of that one I'm gonna go with "listen. And don't patronise."

On the other hand, I've worked in customer service long enough to know that most of the time the customer really doesn't have a clue what's going on, and I can't imagine patients would be that much different. I'm better educated than average and I also have a mother who's a GP, so yeah, I"m speaking from a position of privilege.

Iunno. *helpfully unhelpful*

*tilts head*

Some things I appreciate in a health professional:

- I talk in circles, especially when distressed, so I appreciate a doctor who can ask the right questions to get a straight story out of me
- A hefty dose of Listening Skills to go with that is crucial, though! I'm really, really bad at communicating with doctors and/or shrinks. I feel like I'm giving them information and it's going into the wrong boxes or getting misprioritised or something, because the conclusions the doctor comes to are usually VAGUELY related to what I told them but don't match up at all with what I tried to say was most important.

Uhmmm... some other things...

- not assuming that every girl on the pill is sexually active is a good start! Also I have the impression that some doctors used to think I was lying about my virginity in order to avoid pap smears.

- I had a doctor who was very brisk and efficient and who did believe me about the virgin bit. I liked her, she never badgered me about pap smears and gave orders that no one was to do an internal ultrasound on me. I was quite relieved about that but also a bit annoyed because she just flat-out declared that "we won't let them do that if you've not been sexually active". I'm a grown-up! I would actually not have minded if it were necessary, and I'd have preferred it if she didn't seem quite so much like she was making a Special Virgins Rule for me.

- Oh, and speaking of: Don't make pelvic exams weird by going on and on about how it shouldn't be weird. I saw this urologist when I was about thirteen, and he had to have a look at my external ladybits. Being thirteen, I took my mum in there with me, and he subjected us both to this big long horribly embarrassing ramble about how I needn't feel uncomfortable, my mother had lots of exams like this when she was pregnant with me. As it happens, I wasn't uncomfortable until he gave me this signal that I ought to be.

Aaaaand I would like GPs not to play home psychiatrist! Telling me long rambles about how I remind you of you when you were at uni and were an over-achieving whatever (not you you, general you) does not help. Ditto all doctors and mental health professionals who seem to think that they have the responsibility to police my career choices. I swear my doctor in Canberra was measuring the success of my psychology treatment by whether or not I had given up the idea of going back to uni.

I also concur with the things K said.

Well, I have lots of thinky things I could say, but I'd mostly like to talk about Chronic Fatigue. I don't have it, but my brother does. He's had (and continues to have) an incredibly difficult time.

He's continued to have problems because doctors tell him he isn't sick, or that it is all in his head. Certainly he does have problems with depression - but I believe it is the CFS that is making him depressed, or at least agravating it, not the other way around. I know it is a really difficult thing, but I wished more doctors had more information - because I feel if we'd gotten on top of it at the beginning it wouldn't be at the stage it is at now...

THIS. this this this this this.

I was going to chime in about how I have a chronic illness, and how fortunate I was to have a GP when I was a teenager who correctly diagnosed me and an excellent GP now who is learning about CFS/ME to better treat me; and all the crummy times in between where I didn't feel like I could actually tell my GP at the time that I had a CFS diagnosis because for years it's been conflated with depression, general apathy and laziness.

Chronic fatigue is simultaneously a nearly impossible illness to treat and one of the most personally destructive illness I've ever encountered in my life, and even having a physician who is aware enough of CFS/ME to take seriously the 10+ years I've been living with it is the difference between despair and hope.

And that's true of most, if not all, chronic illnesses, I think. If you're planning on being a GP, the various manifestations of chronic illness are something to look into, because in my experience the only person advocating for the patient of those illnesses are the patient herself and (if she's fortunate) her family.

whew, that was a screed. But I was a bit shocked to see someone else mention CFS before me.

I ditto the two comments above!

I got sick when I was about 6 years old, eventually diagnosed with CFS. The stigma attached to this illness is mind numbing. Even though it primarily effects the immune and nervous systems (I believe WHO classifies it as a neurological disorder?), it's treated as a psychosomatic disorder. I was not offered anything except anti-depressants. Still, 16 years later, doctors appointments still feel like going into battle. Despite having no treatments to offer, I have literally been laughed at in the face when I suggested I try an FDA approved drug that has been trialled successfully on CFS/ME patients. I was laughed at when I spoke of the latest xmrv research into CFS, I was told - it doesn't matter, even if they find something it makes no difference. Whenever I bring up symptoms with any doctor they are, in most cases, swiftly dismissed, either because it's all in my head, or because I have CFS and therefore any symptom that presents is just something I have to put up with.

The irony is what little energy I have I am using to study pre-med. And yet still I am laughed at as though I am a silly little woman grasping at straws for a disease that they don't think is worth their time.

Doctors above all should listen, if a patient comes in and says that symptom a b and c are really bothering them, take note, listen to their concerns, and don't dismiss them as trivial.

If a suggested treatment doesn't work, don't blame the patient. Try something else. If a patient suggests an unreasonable treatment explain to them why you think it would be inappropriate. This will make them feel included instead of making them feel as though you just don't care.

Most people with chronic illness experience a long list of symptoms, when they come to see you they aren't telling you every symptom they have, just the ones that are bothering them the most. A lot of my doctors have been surprised to learn that I do still have all the same symptoms as when I first came to see them, it is just unrealistic to repeat myself every time I have an appointment (they usually laugh and say you can't have all these symptoms anyway). So I guess my point is check up every now and again to see what actual progress has been made. And don't make the assumption that the few symptoms they list are the whole picture.

God I ramble lol. Hope that's helpful in some way, good luck with your studies :)

Hmmm. Basically what I want is a doctor who will tell me what's going on as much as they can in as much detail as they can but without overwhelming me with medical jargon and then making me feel stupid and talk to me condecendingly for asking what the fuck they mean.

...Bad experience. Still bitter. Sorry.

But yeah. I don't care if they're nice, bastards, old, young, crazy, have cold hands, inaprpriate... Whatever. I just want them to be clear.

I guess I've been lucky enough to avoid many truly horrible experiences with doctors - or at least, they all happened when I was too young to really remember them now :P there are really just two things:
- Ask me questions, and take your time checkin' everything out. When my doctor asks me two things and then decides they already know what's going on, I get paranoid, even if they really can tell right away o____o
- This might be more on the system side rather than down to the doctor themselves - but if at all possible, don't ACT like you're rushing through my visit even if the clinic is completely swamped and you are. It's probably not a problem in most areas, but now that I'm going to school in NYC going to the doctor/hospital is such hell that from now on I plan to stay put and be sick in my room :( they rush by you and push you out the door with a prescription so fast that I don't even understand how they got a good look at anyone. (And apparently the answer is that they don't, since the last time they gave me medication for strep throat when I clearly did not have strep throat. And the test finally came back negative... a week and a half later. Thanks guys. Good to know now that I didn't have strep throat last week.) Not to mention the time they took me to the hospital in an ambulance because I almost passed out in the hallway only to leave me sitting there, alone, in the waiting room for over TWO HOURS. No one even asked me if I was all right. Now, obviously in any hospital and especially in a big city like New York, tons of people are in much greater trouble every day and I was in no way deathly ill, so I'm not saying they should have rushed me in over some poor fellow who was actually in pain or something. But it was the first month I'd ever been away from home and my parents, I was in the middle of this city I didn't know, at a hospital I didn't know, in the middle of having a panic attack. And no one even bothered to say "don't worry" or "are you all right?" D: for two hours. TWOOOO HOURSSSSS. Then they released me and I walked out all fucked up from crying for two hours and found myself in the middle of NYC at 1 AM with no idea of where I was. Suffice it to say that was not a very good day.

annnnd I don't think this applies to you, but one of the single most traumatizing experiences of my life was the first time I went to the gynecologist. I had just turned 18, and like someone else has mentioned, I don't think they believed me when I said I was a virgin. Well, maybe she believed me after I started crying and shaking when she stuck cold and painful things in there :( all the while acting confused like "this really shouldn't hurt" and I was all "WELL IT DOES. IN MANY WAYS." In my head. Because I was too busy trying not to cry like a little girl to actually say anything.

URGH @ "This shouldn't hurt". It's not just gyno stuff docs say that about, it's everything. Even things that involve shoving really big needles in uncomfortable places.

Seriously I'm sure that "this won't hurt" is a good thing to tell patients, psychologically, but being told that you're basically making up the pain is kind of shit.

Mostly to listen, and to try to take it seriously when I say I have a serious concern instead of dismissing it. All of the bad experiences my family and I have had with doctor have been because they wouldn't believe what was going on. Anecdotes, if those are helpful (NB: I come from an area with unbelievable bad doctors):

-When my mom was first suffering from undiagnosed celiac disease, she lost weight until she was about ninety pounds, the doctors refused to believe that she wasn't anorexic, even though she made it quite clear that no, she didn't want to be deathly ill, actually. Multiple doctors did this, and it finally took my dad doing independent research on celiac disease and presenting it to the doctors to get them to believe it.
-When I had a virus that was giving me a rash, giving me a terrible cold, and making me lose my eyesight almost completely, the doctor brushed it off with, "Huh, that's weird. We don't know! Weird!" And they basically sent me away. This went on for weeks before an eye specialist worked it out and tried to fix it.

Also, this is somewhat specific, but it makes me reeeeeally uncomfortable when doctors ask me questions about trans-related stuff when I'm in there for something completely different (kidney stones). The doctor at my school's health center, right before I left, asked me all kinds of questions about whether I felt that I (or other trans guys here) would be comfortable coming to the health center for a pap smear. Off-topic asking me to speak for people who aren't me! Not fun!

I've had two really great doctors, and I think one of my biggest things is that... they take me seriously. If I say I have a certain combination of symptoms, that's what they go on. If I say I'm having a specific problem, they work from there. They've also both been really supportive about mental health issues - I think coming at it from more of a, "Hey, that must be a tough situation," rather than, "OH NOES, YOUR BRAIN IS BROKEN," perspective is kind of helpful.

Also, as someone with anxiety issues, I think it really helped when my doctor took the time to listen to what was going on in my life and causing the anxiety. It's not your job to be a therapist, but I felt like I was being treated as a human being rather than as a medical issue, and I think that it helped my GP figure out a better course of action because she had the full picture.

And I realize that if I go in with strep, I need an antibiotic, but where possible, if there are multiple viable options, I think it really helps to let patients make some choices about their own treatment or some chance for input. Even if it's just like, "Medication X and Y are effectively the same for dealing with allergies, which would you prefer?" it helps give people a little more control over the proceedings, which I value a lot.

My worst doctor experience involved my family practitioner putting me on medication for depression when I informed him that I'd begun to see a counselor. At no point did he ask about talking to said counselor, or give any indication that he wanted to speak with her. And to add insult to that particular injury, he had no idea how the medication he was offering me worked.

At the time I was taking a physiological pysch class, which is really what prompted me to go and be tested for anxiety, and so was new to the whole MAO Inhibitors and SSRIs and their function. He either had no idea, or had no desire to take the extra time to talk to the crying 19 year old me.

One of the best things I ever did was stop seeing that doctor.

If I were to give someone advice on being a doctor? It'd be listen, take good notes, and when your patient is a crying mess...listen more.

I loved my Doctorlady in high school because she was chill, funny, and no-nonsense about the things that scared me, like pelvic exams and being much, much too skinny. She is, I think, the only doctor I had (except two of my shrinks) who didn't treat me like a freak or an idiot for having an eating disorder.

She also didn't politely not-talk about it. When my weight charts were messed up, she would confront me and ask that we do blood tests and things of that nature, which was helpful in a different way.

So I mean. That's a little thing. But it meant a lot to me.

Lurker coming out here. I would like a doctor that will actually control his staff. I had major surgery in November that I've had complication after complication with. I had to go to a hospital 4 hours away (Duke) for this surgery because I live in the boonies and my small town docs were out of their league. However, once the problems started up, no one from the facility will return my phone calls in a timely manner - if at all. And I'm not talking a couple of days, I'm talking weeks to months. I would maybe understand if it was just me having a problem with this place, but there's a message board for it and everyone I talk to has had the same thing happen. Right now I am terrified I'm going to die because I can't get the help I need. So dear future doctor, if you get complaints about your staff, please take them seriously. :( (I've written letters. They've done no good)

I could go on and on about the other stuff you mentioned - being blown off because I was heavy, etc., but I figure others will probably nail those.

Nobody else has actually mentioned anything about attitudes towards heavy patients, so if you have some examples you don't mind sharing, I'd be happy to hear them.

Delurking for this... For the record, I'm hardcore asthmatic with a host of crazy rotating allergies, I'm fibromyalgic, and I've been on birth control since I was 16.

For most of my childhood and early adolescence, I had the same GP and absolutely adored her: she would answer emailed questions (ie, "merrycaepa is having symptoms x and her peak flows have dipped to y. Should we bring her in or just up her albuterol for the next week?") that saved my family and I from having to make what would have been unnecessary appointments (nb: my parents were ridiculously well-informed about my health and treatments. I don't think she would have trusted all parents to handle their kids' health that way). She didn't so much as raise an eyebrow when I asked about birth control, and always, always listened. I've developed tolerances to meds that you theoretically can't develop tolerances to, and I've had withdrawal from things you can't get withdrawal from. And even when absolutely no clinical research supported what I was reporting, she still believed me.

And then she up and moved to a clinic an hour away, and I got a new GP. Whom I hated. When I was in and out of her office every month with inexplicable and crippling pain (that turned out to be fibro), new GP apparently wrote "depression" somewhere on my charts without telling me. She says that she meant it as a question/note to herself, but there wasn't a question mark after it, and so I was somewhat surprised to find out, when I got a copy of my chart to fill out college health forms two years later, that I had "a history of mental illness." Which I can't get struck from my records, despite the fact that it's, um, not true. After I took a soccer ball to the face from close range and knew I had a concussion (I'd had them before, also from soccer - I suck at ducking), she asked if my face was tender (well, yes, it was) and diagnosed a sinus infection. Apparently the part where I'd been knocked out from a projectile to the head was inconsequential.

Aaaand then there was the time that a nurse was incredibly bitchy about the birth control. a) Not all of us who take bc are even sexually active - I take it because it regulates my periods, and b) even if I was sexually active, I should not be slut-shamed in my doctor's office. Just. No.

Anyway, the old doctor's office admin was getting increasingly frustrating to deal with, and I wasn't making appointments when I should have been because I hated the new GP so much, so after I got back from Turkey, I switched back to my old GP. I'm willing to drive an extra hour for someone who will listen.

Sorry to have written a thesis here, but it's something I feel really strongly about. Doctors who will listen are worth their weight in gold. Doctors who won't are worse than useless.

Oh, and then there was that time that I went in for a flu vaccination, and the needle was, you know, sticking most of the way in my arm when the nurse started telling me that she'd heard that they caused autism and didn't think people should get flu shots...

...Or, back when I was fighting the depression 'diagnosis' that new GP took it upon herself to 'test' me for depression; she asked me if I'd been sleeping enough and if I cried a lot. Well, I wasn't sleeping enough (I was in an incredibly high-pressure academic program and did technical theater on the side - five hours of sleep a night was a lot, at that point) and I did cry a lot (because I was sleeping five hours a night), but I lied because I knew that she wouldn't listen if I tried to explain the truth. So new GP taught me to lie to my doctor.

I've had a string of great doctors, but two things stand out for me:

* the neuropsychiatrist who absolutely took me seriously when I said I was afraid of becoming schizophrenic (which is one of my most persistent and most irrational fears) and asked me a series of diagnostic questions about it, and then explained to me exactly why there was this myth that it was comorbid with ADHD and why it was totally improbable that I would develop it.

* the eighty year old family pediatrician who looked at my little brother with a fever and a rash and didn't just prescribe him antibiotics, didn't just let him go home, but said "You know, I was doing some reading lately, and I just want to have him tested for Kawasaki's," and so probably saved his life.

So, yeah. Following the patient's train of thought, even if it isn't right and you know it isn't right, as long as you responsibly can, and avidly keeping up with the research even when you have metaphorical doctor tenure.

Because my life has foils, I guess, the worst doctor I ever experienced wasn't that bad, he was a therapist who literally only asked 'How does that make you feel?' and wouldn't help -- all he did was ask questions -- and so I ended up talking up my fears into these enormous monsters that might kill me. Newsflash: the patient doesn't always have the solution buried in her own subconscious, particularly when she's dealing with someone she's never dealt with before. The worst doctor I know about is the one who saw my mom's friend's daughter come in with incredibly intense and sudden flu symptoms and was so sure it was flu he took swabs but secretly didn't actually bother to test them, so that when she came into the hospital later that night with an incredibly high fever and swelling (not on her throat, but huge, on her leg or something) they didn't know what was going on ... and the doctor didn't give her antibiotics, which would have saved her life, because it was streptococcus. And the seven year old girl died. So don't be married to the obvious diagnosis I guess, and also, don't commit incredibly horrible malpractice? And then when you do don't be a Californian doctor under a law that caps wrongful death of children malpractice suits incredibly low?

whatimages said: to ASK that, for a start!

I'm chronically ill and under 25. I have been dealing with mental and physical health problems since my early teens, have acquired various diagnoses on my trips through five different GPs (one for 21 years, then I lived in four different places after that), and I am tired of being treated like a hypochondriac when I'm not. I'm a geek: when I get a new symptom, I do my research. If it fits with an existing illness I have, I accept it (some of them have a ridiculous number of lesser symptoms). If it doesn't, I question it.

What I want from my doctor is to listen and provide intelligent options, alternatives, to discuss with me treatment options that I may have tried and to listen to me, particularly if I say something didn't work.

I want to be taken seriously, not patronised because I'm a young person, because I'm chronically ill enough to be on benefits, or because I'm not a passive patient. I try to take an active role in my healthcare and diagnosis, since I grew up with one parent fighting cancer and the other an alcoholic who is still chronically ill in other ways (I inherited one of his major conditions, an autosomal dominant). I fight as much as is in me to do, but I can't do it without medical help, and I'm not getting much of that right now. It seems to me, from my own experience and that of close friends and family, that a lot of GPs have trouble listening to patients with invisible illnesses, particularly the younger ones, in an unbiased way.

Also, mental health: I was diagnosed with chronic unipolar depression several years ago. Trouble is, I know that my depression is anything but unipolar, but because I had only about fifteen minutes per month with the psychiatrist I was seeing to start with and because I was always anxious during said visits, she wouldn't listen to me, and ever since I've had problems getting psychiatric doctors and nurses to actually pay attention when I try to explain that what is on my file is inaccurate. I know my own mind very well, and my family know me, and we are all certain that I'm rapid-cycling bipolar, particularly given the psychotic features I get from time to time (aural hallucinations, mostly). I have some horrible mixed episodes a couple of times a year. Half a dozen non-psych medications send me in one direction or another mentally - prednisolone makes me hypomanic/mixed, nortriptyline makes me hallucinate, and there are a few others - and my moods swing like a yo-yo swung by a champion. I've been back and forth from one point where I just wanted to knock myself unconscious to make it all stop to considering actually harming myself to get committed to get help. Yet still, nobody will listen to me when I try to tell them what's up.

So yeah... it's all about listening, paying attention, not patronising, and being unbiased with patients, in my view. That's where our system is currently lacking. Hugely lacking, in certain areas (a 17-year-old childhood friend of mine committed suicide a few years ago, my sister has tried several times, I tried three as a teen - all of us from this village, where mental health problems get crappy treatment).

Best of luck to you! And thank you for caring enough to ask.

[In the interest of full disclosure: current diagnoses are hypermobility syndrome (severe - waiting on referral to a clinic - my father has hypermobility Ehlers-Danlos syndrome), fibromyalgia syndrome, asthma, migraines, Raynaud's syndrome, depression and anxiety (having said which, I am certain that I'm actually bipolar and not depressed, which is something with which a psychologist I saw last year agreed). Oh, and hayfever, allergies, etc. I'm on a very low income (benefits only), white, cisgendered female, homosexual (never had any problems with that in seeing doctors), mid-weight.]

Edited 2010-04-16 19:09 (UTC)

I know

synecdochic has had some really bad experiences with doctors- here's the first post on that I could find: why i hate doctors, part #12834 in a series.

I'd like to echo what everyone else says, and say "LISTEN". And, you know, take people seriously.

When I was a child, about four or five, I started getting really terrible headaches. And Mum took me from doctor to doctor, and they all said I was making it up. A few years later, I had a grumbling appendix. Same result. (It stayed a problem until I was sixteen, and I can't tell you how good it is to suddenly have a life without stomach pain!)

So now, I go to the doctor with migraines, or osteo pain, and quite often I'm told that there's no obvious cause, so there's nothing they can do. And I always feel like I'm a kid again, being called a liar and an attention-seeker.

The best doctor I ever had listened to me very carefully, recommended a physiotherapist for my knees, took extensive notes on my headaches, and generally took me seriously. Even when he explained that people with depression and anxiety are often hyperaware of pain and discomfort, I didn't have the sense he was dismissing my problems.

Of course, later he tried to ask me out, and obviously I could never go back. Don't hit on your patients. It's freaky.

Wow, you are really throwing it open, asking what people think about their doctors. :o But it's awesome that you're asking, anyway.

I wish I could cut-text comments because I go to a lot of doctors. ;) I'll try to condense! Some I still go to, some I've dropped along the way. ATM there are 3 I see semi-regularly (a GP, who I see more than I would like because we can't seem to get this thyroid thing taken care of, a gynecologist every few months who is actually 3 people depending on who is available, and a neurologist aka Dr. Claw), and I'm thinking about 2 more (endocrinologist because of the aforementioned thyroid issues who my sister likes, and a guy a good friend is obsessed with who does acupuncture for her who files everything with insurance as chiropractor visits because most don't cover acupuncture. I don't even know where to start with that one, but let's assume you will work in a decent system).

Basically I think it comes down to The Ones Who Seem To Give A Damn, and The Ones Who Don't. I've recently realized this extends to people the dr. surrounds herself with, which may not always be under the dr.'s control, but... if you can (esp the ones closest to you from the patient perspective), pay attention to how they treat people, I guess. My doc signed a letter to me but I'm guessing the nurse wrote it (& fibbed a bit) because he took notes while we were talking and half the letter is way off on things like 'current dosage' and 'reasons for taking,' etc. :( The nurse is my main contact w/him outside of his office, and she is not pleasant to talk to.

Demonstrating they give a damn: Claw gives his minions good feedback while I'm in the room - even 'you did a nice job with that patient history' etc - it tells me he cares that people around him do well. I appreciate being told that "other patients have said this procedure feels ____" if the doc hasn't experienced it. Other responses have mentioned listening, which is good, even note-taking on paper or computer shows that what the patient says means something - to me it does, anyway. And where you can control it, surrounding yourself with people who also give a damn is awesome. Blinded Examiner had a lady following her around to watch last time, and demonstrated similar teaching techniques. "When I hit this reflex point on the arm, should the hand go forward or backward at the wrist?" (I had no idea, and I'd been whacked dozens of times there ;) )

Demonstrating they don't: Claw isn't perfect - he mentioned in passing that the vitamin he'd prescribed was animal-derived, with a jokey "Hope you aren't a vegetarian" 3 months after I'd started it. I'm not, and if I had been I'd probably have mentioned it before then, but it wasn't really funny. Also the aforementioned letter, or acting like a life-changing illness is no big deal, or blowing off symptoms. (I told a dr. many years ago that I had a strong tingling in my feet; he said I shouldn't wear heels so high. I said I rarely wore heels. He said 'well, stop wearing them altogether' and didn't do anything. Later it turned out this was early neurological damage.)

I mean - not that you should order an MRI and a lumbar puncture for every patient with bizarre tingling - I doubt he could have found anything else even if he'd looked. But even simple 3-minute follow-my-finger and reflex-check type tests, even if they didn't turn up anything, would have suggested that it was something worthy of his time and I wasn't just another girl whining because her shoes were too high. Maybe I wouldn't have ignored other symptoms so readily, thinking that they weren't worth investigating. I don't know. I still get angry thinking about that experience, and I can't even remember the doctor's name.

So, lots of stuff, one conclusion: give a damn. I suspect the rest of it just follows along. :) And you are going to be a fantastic doctor! Even asking for feedback says that you already give a damn, and you haven't even seen your own patients yet.

I treat fibro with acupuncture, and one of my first tests of a new doc/nurse is how they react when I mention that. The ones who refuse to believe that it works for me are likely to refuse to believe other things I tell them, too.

(acupuncture ftw!)

Mostly
01: take migraines seriously. Please.
02: don't box me into that WHITE FEMALE LATE TWENTIES LONG TERM RELATIONSHIP bracket. I'm specifically talking about (typically) female doctors who are just babies!babies!babies! about every damn thing, and then run all possible diagnosis/treatment options through that filter. I'm not pregnant, I'm on very long term birth control, I actually want to get my ladyparts snipped* and I am telling you that denying me migraine medication because I might want to get pregnant in the next month just. isn't. FAIR!

* gosh, I could write a book on how much of a red rag this is to just about every doctor I've ever met. I know it's a deviation from the heterosexual norm, but gosh, if you ask me why I haven't had children yet and I answer in a totally non-aggressive way that I'm not planning on it, don't call me mentally defective!

OK, so from reading the above it's clear to me I'm way too institutionalised to see this from a patient perspective, which is interesting (that's 4 years since graduation, of which 1 year spent in research, 4 months in a GP post the rest in hospital medicine). The hospital perspective colours things a lot too, and is very different to ongoing outpatient care. There are many good points here, but you are likely to spend at least the first 3 years of your training in an environment where 10 minute slots and long term treatment relationships don't exist.

Some very good advice I had in my 4th year still sticks with me, which is that you, as a person, will be a certain kind of doctor. We all will. We all find ways of practicing that suit us, and most practitioners will end up working in a manner that draws the kinds of patients that suit their way of practicing. This is especially true for GPs, who build up their lists of patients-who-like-them. (Friends who have gone into GP though do bemoan that if you are nice and interested in mental health, your partners will very quickly send a stream of heartsinks your way, and this is not necessarily sustainable.)

Working in hospital medicine there is less of a doctors-and-patients-choose-each-other dynamic. But working in teams gives us some room to act there. I do pretty good hand-holding (if I say so myself), and my empathy-face is pretty good too. I tend to accumulate a few sad people who need a bit of both in whatever job I do. Tonight I'm on nights, covering (among others) the ward I worked on last month. It gives me enormous satisfaction to see a couple of my saddies tonight and get smiles from both.

So yeah, practice your listening, your empathy, your communication (oh so much practice that), because they're important in all jobs. But don't forget that patient satisfaction can't be your only measure of success. Tonight I endured an ear bashing from a(n otherwise delightful) lady about how awful it was the day resident kept her waiting four hours for a senna prescription. In those four hours I know he spent 2 of them at an arrest and 1 and a half with a peri-arrest COPD patient. (I have a theory that in most cases, for inpatients, the volume of complaint is inversely proportional to the sickness of the patient, but that's another whine).

That's probably enough cynicism. Good luck with the thinky thoughts on all of this.

I've always been very grateful when I've found doctors who are willing to talk with me about my condition sensibly, even if I'm in floods of tears, but who also hand me tissues as needed and don't make me feel like an idiot for crying.

I don't like it that I cry when I'm feeling physically bad, or emotionally bad, but it happens pretty reliably.

Comforting just makes me cry harder, and a doctor's appointment isn't long enough to wait till I'm all better (which could be hours, if I'm really run down).

The doctors who have listened when I've said I'm fine and I'd like to just keep on topic have been wonderful, because they've then been able to get enough information to make useful diagnoses.

It occurs to me that it's probably not so good, if a teenage patient responds to a birth-control question by saying she's not considering it right now because she's in a lesbian relationship, to say that you won't put it on her 'record'. It can make the patient feel remarkably uncomfortable.

I've always liked it when my doctor shares information with me, being clear about what he or she doesn't know, as well as about what is known.

Here via friendsfriends, and I thought I would add a constructive comment:

The best doctor experience I've ever had was with the nurse practitioner at my university. I'm a compulsive skinpicker, I'm kind of heavy, and I get cold really easily, so the thing I hate most about doctor's offices is that usually the first step is "I'm going to need you to change into a gown for this." Especially when I totally don't need to! Gah. But on to the good stuff: Because I'm a skinpicker, I'm really familiar with what my skin's doing at any given time. So when I started getting these weird itchy painful bumps, I went straight to the nurse's office and said "I've got these weird bumps on my back." Here's what she did, in order:

1. Believed me when I told her it didn't feel like acne.
2. Didn't make me take off my shirt or my bra, even though I had to lift it to show her.
3. Said, "Yeah, you totally have shingles, let me show you why" and then
4. Got out a medical textbook, explained what a dermatome was, showed me the stages of bump-growth and what I should expect, and then to top it all off...
5. Complimented me on being quick enough to catch it early (which ended up saving me a lot of horrendous pain, since I got put on antivirals right away), without once making it sound like of course I was body conscious, and haha isn't it funny that my tendency to scratch myself to pieces paid off this once (because that's what my self-esteem was saying at the time).

Flat | Top-Level Comments Only

following on from my last post

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via kat_lair (can NOT fix the link code X_X)

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