Friday, September 17, 2010

Dear Doctor

Dear Doc B,

I'm writing this in the hope that you remember me. I think that you might; you considered me a thorn in your side for a while.

I want you to know that I don't hold anything against you personally. You're probably a very nice person to interact with outside of the doctor/patient relationship. My issue is with your professionalism. Not your skill as a physician, exactly, but your listening skills.

I have a lot of respect for the education you've received. My hat's off to anyone who can make it through medical school and residency. Nursing school opened my eyes to the kind of rigors physicians are put through; those of you who make the grade do so because you're tough. My issue isn't with your level of intelligence, however; it's with your listening skills. Your HEARING skills, to be more precise.

Doc, you may have thought that you listened to me, but I don't think you HEARD me. You didn't take me seriously. You wrote me off, you told me that you didn't know why I was so ill intermittently but that I should just learn to live with it. You labelled me - not only in your own mind, but to other providers, too - as a hystrionic hypochondriac and also as a drug seeker. It didn't seem to matter to you that I wasn't asking for narcotics and that I made myself ill taking NSAIDs, you ignored the fact that I came to you asking for a medically managed withdrawl from narcotics after a car accident and subsequent surgery, you just saw me coming in complaining of pain and you made up your mind that that's what I was after. You even wrote it in my medical records. You ignored the times when I refused narcotic medications from yourself and from other providers, you ignored that I asked for you every single time I was seen because I wanted continuity of care....you ignored those things and you got a tunnel vision. Do you know how difficult it is to have something like that written in your chart, Doc? Every physician I've seen since you wrote that has initially looked at me with suspicion.

You're probably wondering why I'm writing to you now, years after we last met. I'll tell you why: I have Crohn's disease. I've HAD Crohn's disease for years, even way back when I was your patient. It's not only attacked my gut, it's attacked my joints and my kidneys, too. All that joint pain I kept complaining about? It was real. The belly pain and constant diarrhea I came to you with? That was real. The fatigue, the hair loss and weight loss and the depression that came and went? The recurring kidney stones and reflux, the gall stones and billiary colic? ALL OF IT WAS REAL AND HAD AN ORGANIC CAUSE.

It wasn't all in my head. It wasn't something I was making up. It was real, doc, and had you not been so determined to prove that there was nothing wrong with me, you might have seen the signs and symptoms that, according to my gastroenterologist, were 'blaringly obvious to anyone who cared to look' and you might have ordered the right tests and come up with a diagnosis.

I consider myself incredibly lucky to have found a physician who was able to put aside the bias you placed in my chart (based on a falsehood, I might add) and see me as a sick person desperate for help. Instead of taking the preliminary negative results of a colonoscopy and endoscopy as a firm indictation that nothing was wrong, he decided to investigate further. "There's another 1/3 of your gut that I haven't seen yet" he said. "Don't worry, we'll figure this out" he said. Those words were like a ray of light in the darkness, and they made me cry. It felt like finally, someone was validating the way I was feeling.

He took me at my word, Doc. He went and looked further, and he saw that the 1/3 of my gut he hadn't seen yet was eroded and ulcerated. He looked at the abnormal blood tests, at my lack of renal function, at my swollen and painful joints, at my weight loss, at my malnutrition. He took the time to figure it out instead of dismissing me the way you did. He took the time, and he got an answer.


I'm not saying that he is a better physician than you, or even a better person than you. I'm simply saying that you might want to re-think your bias; that you may want to try to put aside your cynicism a little more often when confronted with a patient who keeps coming back with the same symptoms, telling you that something is wrong. Perhaps if you had done that with me, I'd have better renal function than I do now and I wouldn't have been as ill as I was...I wouldn't have thought I was dying. I can't say with any certainty that your lack of concern led to my kidneys only working at roughly 30% of their original capacity, but I can say that they're damaged because of the effects of undiagnosed Crohn's disease that I had for YEARS. I can say that had you NOT insisted on seeing me as the pain in the ass patient you might have been able to help me.

I know how easy it is to become cynical when confronted with patients; I've experienced it first-hand. I've also had the cynicism come back to bite me in the ass. I hope that this letter and my diagnosis is YOUR bite in the ass, Doc. I hope that you don't just blow this off as sour grapes on my part; I hope that you take it seriously and that you use it as an opportunity to reassess the way you look at patients. I don't want anyone else to go through what I went through, and I don't want you to treat anyone else the way you treated me.

Now that I have a diagnosis and am being treated adequately for this disease, I'm doing really quite well. It wasn't until I started to feel better that I realized just how awful I had been feeling for so long. I know that it may not seem like it, but I harbor no animosity towards you. If you were still practicing in my area I wouldn't be telling other patients that you're a horrible physician, and I won't be campaigning for the AMA to revoke your license or penalize you. I simply want my case, my illness, to be a wake up call for you. I want you to learn from it, to learn from me.

Much love and many regards,

NM

4 comments:

Anonymous said...

Just found your blog this morning. What a great letter. I hope you sent it to the actual doc as well. And I hope he heard it this time around.

I have a friend I'll be sending over who may find this helpful/useful, as he is dealing with similar problems, doc(s) who don't believe there's something really wrong, even though there clearly is. Thanks for sharing.

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