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Monday, May 16, 2011

What is a doctor's truth, what is a patient's?

Years ago, I heard a doctor speaking to a support group. He was discussing neurological issues for those of us with trigeminal neuralgia. In passing, he mentioned x-rays and how people sometimes worry about them and their possible association with certain health risks. He reassured us that getting a few x-rays during our lifetime was not something about which we should be worried.

After the meeting I approached him. "About x-ray risks" I started to say. He immediately interrupted me. "As I said there is no reason to be worried about a few x-rays over your lifetime causing cancer or other medical problems." I looked at him. "Well, I have had probably 500 x-rays." His eyebrows rose as his mouth formed an O shape. "500?" I nodded. "Yes. I've had arteriograms and angiograms, 2 rhizolysis procedures (a closed surgical treatment that relies on repeated x-rays to determine where the needle is placed.) venograms, and cat scans and." He interrupted me again. "That is a lot of x-rays." Then he turned away and started talking with someone else. Did he not want to listen or not want to answer?

It is not a worry I really have, maybe I should but in the scheme of things it would be very low down on my list.

It does make me think of the times doctors tend to pooh-pooh patients when they complain of pain. We are asked "Is it really that bad?" Maybe if we thought about it once asked, we would say, "Oh, you know what, now that you ask, nah, it is not that bad. Never mind."

Sometimes they do not think to ask the follow-up questions.

When I was a teenager my little finger on my left hand really bothered me. It was very bent and had a big red bump towards the side of the joint. Any time I put pressure on it, for instance when I was writing, it would be very, very unpleasant.

Dr. Horvath: It hurts when you write?
Me: Yes, a lot.
Dr. Horvath: Which hand do you write with?
Me: I'm right-handed.

He gave me a whithering look, as though I was the stupidest person on the planet. In those days I had not yet learned to be forceful with a doctor. (He was a doctor, I was merely patient.) "Then it does not bother you when you write." Looked at in his context, I am right handed, it is the left sided finger, it makes sense. What a stupid person I was. My complaint had to be nothing more than made up or an imaginary pain. Maybe typical teenage angst masquerading as finger pain.

I left his office feeling the fool. It never occurred to me to say, 'wait a minute, when I write I hold my left hand against the desk in such a way that I put pressure on that finger.' Of course the answer is the old joke - then don't do that - but I did not think of it. I only knew I had terrible discomfort with a finger that had a big bump in the joint and I wanted help for it.

All he had needed to do was follow up. "Then how is it that it is your left finger that hurts when you write?"

I had a neurologist write in my chart "There are days like today when I believe in her pain." I saw the chart years later: rarely does a patient get an opportunity to know what they have written in this 'for eyes of all but the patient' paperwork. He had seen the surgical reports that proved the diagnosis of trigeminal neuralgia. He was aware of the reason I had my trigeminal neuralgia, the birth defect, and yet he did not want to accept my reports of pain. Had he told me this outright it could have saved a lot of aggravation for both of us. I would have stopped being his patient and he did not have to have a patient he obviously did not trust.

500 x-rays? Disabling pain? It can be true. Don't surmise. Ask me and then we will both be on the same page.

3 comments:

  1. Wow, What an intimate post and I saw your point of view quite easily, but I wonder did you change doctors after you read the notes?

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  2. Thanks Theresa,
    I had long finished with this man before I saw the note. He did clarify for me some of the other things he had said and ways he had behaved towards me. So much simpler had he just said it upfront.

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  3. It's a shame that one would behave such in the way he did, hopefully not all are like that.

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