I hate going to the doctor. I really, really hate going to doctors. Nurses are usually okay by me — overworked, underpaid, and stuck with thankless grunt work as they generally are — but after Ethan was born and I sobered up from the fantastic intravenous drugs they pumped into my system for a week, I realized how much I hate seeing doctors. Sure, those docs saved my life, but not because they listened to me.
If they’d listened to me and bothered with a medical history, they could have avoided chalking up my multiple ER visits to ignorance and access to Medicaid and perhaps seen that my sisters too experienced some complications with childbirth, and that my older sister and I shared symptoms that are, yes, unusual but completely treatable instead of nearly killing me. Now, not being a medical professional, I’m sure the doctors that I had contact with at that time were operating under some strategy that I’m not familiar with. Occam’s razor, et cetera. They were also operating under some seriously shitty assumptions that led them to mistreating my illness until somebody made a connection and, oops, guess we should have admitted her for tests. Let’s get that baby out today!
You could say this turned me off.
Even when I was a private insurance holder I avoided seeing the doctor until there was nothing else I could do on my own and whatever ailment wasn’t gradually getting better. Earlier this year, after my private insurance went kaput, I had to suck it up and see a doctor about the flu. I spent six months paying off the debt.
I left work a few hours early on Monday when I couldn’t sit at my desk any longer. Thinking it was a bad UTI (which I’ve had a problem with since pregnancy), I planned to go home and drink a gallon of cranberry juice with ten jugs of water and call it a day. Mom convinced me to go to the doctor since these things have a habit of turning into bladder and kidney infections and, since I had a positive and fairly inexpensive experience with this med group the last time I went, I figured it was probably better to get some antibiotics than rely on cranberry juice with added sugar.
This is the point at which I admit I should have gone to the Glorious Women’s Revolutionary Health Clinic (aka Planned Parenthood), but I was on the wrong side of town and the idea of driving ten miles in the opposite direction was unthinkable with the pain in my gut. So, in I go, fill out the paperwork, ask if I can pay ahead and get the discount, clerk says yes, nurse does the run-down of symptoms and tells me to put on a gown because they’re going to have to do a pelvic exam.
“I have a history of UTIs,” I said.
“Are you allergic to any medications?”
“Not that I know of.”
“The doctor will be in in a few minutes.”
“By the way, I don’t have any insurance, so I need to keep this affordable.”
“No problem,” she says, “no problem. First you need to pee in this cup.” Twenty minutes later the doctor come in and asks if I’m allergic to any medications. I answer in the negative and they proceed to start an awkward and embarassing pelvic exam. This was not your usual exam, this was a bumbling and awkward mess. I cringed and balked while they fumbled with their equipment and supplies, me naked from the waist down while they joke about their fifty years in medicine combined, slowly realizing that neither of them had bothered to ask me any questions other than what my symptoms were. Both doctor and nurse apologized separately later for their lack of “finesse.”
Finesse. Finesse is a shampoo, it’s something you think about on a first date, and I don’t want finesse when you’ve got a speculum shoved in my nether regions. I want fucking efficiency.
Their diagnosis? I do not have a UTI, I have a pelvic inflammatory infection. They both left the room and told me to get dressed. Another ten minutes later, the nurse came in to give me a shot of antibiotics.
“How exactly does someone get a pelvic inflammatory infection?” I asked.
“Usually it’s from chlamydia,” she said glumly.
I looked at her, both astonished and skeptical at this news, and in my defense, a tad humiliated from the wreck of the exam. “Really. Because I’ve been in a monogamous relationship for the past two and a half years and if you’re telling me that I have chlamydia there will be some shit going down at home.”
“Don’t get too upset,” she said, looking a little off-put with my language. “Sometimes people get it from vaginosis, too.”
“That’s funny, I have a history of that too ever since I was pregnant. You didn’t take my sexual or medical history.”
“Well, we had to make sure.”
“You didn’t take my history.”
“We had to make sure.”
They had to make sure. Of course they had to make sure. Although it’s clear that in my case the doctor and/or nurse should have bothered with my medical history like good prefessionals tend to do, it’s pretty well-documented that it’s easy to get an STI when your partner is sleeping around and lying about it. But at no point was my medical history brought up, and I, neither a medical professional or particularly comfortable in the hands of even the most competent of medical professionals, blindly trusted the process. Here’s what I figure:
First, this is an urgent care clinic. Beset with the burden of explaining 200 times a day that no, they can’t prescibe a “cure” for the common cold, these employees have a rather jaded sense of what brings people into their office in the first place. Can’t blame them.
Secondly, a young woman who is probably sexually active walks in with a “female problem,” they can chalk it up to an STD. Occam’s razor and all. All things being equal, the simplest solution tends to be the best one. Right? Right. Because to me, finding out if a patient has a history of particular symptoms or illnesses would add to the finding of the simplest solution. More information equals better. I was not asked about sexual activity or pregnancy history, and the nurse, when I provided information about what kind of birth control I was on, hadn’t heard of it. And perhaps this historical probe, no pun intended, would have avoided a series of nine tests that in all cost me $450. At least they prescribed generic medication.
This is why I hate seeing doctors. Too often have I experienced the assumption that I as a patient am too ignorant about my body to know what is ailing me, that I can’t understand technical terminology, that I can’t make sane choices about what happens to and with my body. Doctors assume the role of gate-keepers, a role exacerabated by medical jargon foreign to your average patient, inefficient interaction with patients, vague instructions for patients, and centuries-old traditions that are confusing to patients. And to me, as someone who wants to respect medical science but has been burned a few too many times to take comfort in it any longer, this area of the medical mystique is the shittiest part. For all that is wrong with the medical industry and all that is out of the doctor’s hands, the little but incredibly important things that, when ignored, widen the berth between professionals and the people they serve are completely within the hands of individuals.
This shit always happens to you.
Take your meds and I hope you start feeling better.
Coincidentally, Morning Edition on NPR had a thing this morning on confusion over prescription drug labeling. They had a guy on who had some sort of infection, and the doc gave him antibiotics, on which the label said “take four times daily”. So he did, took the entire bottle, and the infection went away…and returned a week later. So he calls the doc, and the doc says “Did you take the whole bottle?”
“Yes.”
“Did you take the 2nd bottle?”
“Huh?”
Apparently he was supposed to get a refill (the label said, in really small print, “good for two refills”), but no one bothered to tell him that.
My doctor prescribed me antibiotics before my surgery. (I’ve never undergone anything more invasive than an endoscopy before, so.) I went down to the pharmacy, and had to wait for the mandatory counseling so they could make sure I was taking my pills right. The pharmacist said I should start taking them right away, and that I should take an extra one that day so as to get the correct dose. It sounded strange to take antibiotics two weeks before surgery, but I assumed he knew what he was talking about. They were all gone about a week before surgery, so I called my doctor, and, well, post-op antibiotics. Duh.
When I was 19 or 20, I fell while rollerblading with my sister (then 4 or 5) and broke my finger. (Very badly, the knuckle was in many pieces, and it was sticking out at a 90 degree angle from where it was supposed to be.) My father brought me to hospital, where I went for x-rays. He fell asleep, and my sister, feeling like it was her fault (I fell while following her) came with me.
At the end, the doctor told me that I had “shmushed [my] finger”, and then started talking to my ‘daughter’. My sister fixed up that confusion, and the doctor turned back to me and explained that I had broken my knuckle into four or five pieces, and one of the pieces had been broken up into dust, etc.
She then made nasty comments about my pain tolerance (granted, non-existent) and how I’d be in trouble when I gave birth, but she stopped acting like I was a moron.
I refused to see the clinic at my grad school because, when I had an *ear infection*, they wouldn’t see me without a pregnancy test. I had surgery where they took my word for not being pregnant — they can look in my ear without risk.
I’d like to tell you that it’s better when you are an insured patient going to the same doctor over and over, but it isn’t. They’ll remember nothing, they’ll write things down and never review them, and even after you have told the receptionist, nurse, and even the janitor what you are there for that day, the doctor will still ask you why you are there.
Why are any of us here, really?
These people don’t listen. They are operating off of a checklist. Sometimes your problem isn’t on their checklist. They still get paid even if they can’t do anything for you. Some of them even have the audacity to whimper about how they wish it was time to go home already.
I hope you feel better soon. I have gotten to where I refuse tests when I feel like they are casting too wide of a net or they are just practicing CYA medicine.
Wow, Lauren. What a maddening, dispiriting experience. I hope it was, at the least, cathartic to write about!
I refused to see the clinic at my grad school because, when I had an *ear infection*, they wouldn’t see me without a pregnancy test.
I dated a guy in college who went to student health with a miserable sinus infection. The nurse looked at him and said the doctor would be in shortly. The doctor came into the room, reading a chart, said hello, and immediately launched into “Well, the results of your pregnancy test are positive.” J nearly fell off the exam table before the doctor looked up to see that he was dealing with a very cis guy.
Nothing like medical idiocy to drive you up a wall.
I stopped seeing my old gynecologist for a similar reason. I went in with bacterial vaginosis. I knew what it was, I had it before. So there I am, legs in the air telling her that I’ve been in there with the same thing before (did she not look at my records!?) and she looks down at me and tells me that “you never know” and made some comments hinting that my husband had cheated on me and brought me home a present. If you are a woman and under 30 they automatically assume you know nothing. Of course it was bacterial vaginosis, not that she told me, she left it to a nurse to give me the script.
Then there was the time I was supposed to take antibiotics before a surgery and my doctor (after asking about allergies) still prescribed penicillin for me. I didn’t even notice, luckily the pharmacist caught it.
Everything you say is true. I mean, I wish I could say different, and officially as part of my job I’m supposed to say different, but you’re right: If there’s one area they consistently screw up, it’s the history.
It doesn’t help that medicine has traditionally been a profession of nerds. The same guys (and I’m sticking with “guys” here because I don’t see this problem as much with female physicians, please forgive the “woman are like this and men are like that” stereotype a moment) who get MDs would be just as at home in engineering or finance. They are very good with body parts but often terrible with actual whole people.
I’m sorry it went so badly. Feel better soon.
These people don’t listen. They are operating off of a checklist. Sometimes your problem isn’t on their checklist. They still get paid even if they can’t do anything for you. Some of them even have the audacity to whimper about how they wish it was time to go home already.
Yup. I’m currently trying to get my PC doctor to (literally) sign a form that will allow me to change my name and gender. I bring in the form, they sign it, I leave. Probably about ninety seconds. I can’t even get him to return my calls.
The stupid HMO call line probably can’t even deliver a message to the effect of, “Dude, I need to talk to you. Please call me. I need some help filling out these forms. No, I don’t need a *%$@! physical.”
Oh man Lauren. I can relate… when I was pregnant for my daughter, I had some scary spotting and with no insurance and no doctor (it wouldn’t kick in for another month) I headed to the ER, where they ran STD tests. Despite my having been in a monogamous relationship for three years and my most recent pap being fine. Tried to tell them that, they wouldn’t listen. A week later, when I’m back because I’m bleeding all over the place, they ran the same freaking tests again, despite their being negative just a week before. I hope you feel better soon Lauren. It sounds absolutely awful.
It doesn’t help that medicine has traditionally been a profession of nerds. The same guys (and I’m sticking with “guys” here because I don’t see this problem as much with female physicians, please forgive the “woman are like this and men are like that” stereotype a moment) who get MDs would be just as at home in engineering or finance. They are very good with body parts but often terrible with actual whole people.
As an engineer, let me say that listening to people’s problems constitutes a large part of my job. Why should I waste time getting things wrong when people who know more than me can help get them right? I know engineers who operate like this doctor, and they’re bad engineers, just like this guy’s a bad doctor.
I’m not trying to give the sort of ‘But men experience x!’ response that we all hate so much. I just want to defend the reputation of engineers from the charge that we’re some sort of socially and relationally stunted subspecies. The good engineers I know are good communicators who listen and the things that people tell them. The bad ones don’t.
They called back with the results today, negative on all counts. Pelvic inflammatory disease it is.
The good engineers I know are good communicators who listen and the things that people tell them. The bad ones don’t.
Same with doctors.
I had the opportunity to see a doctor before my insurance ran out that didn’t have desk help, just an answering machine. She sat with me for two hours, did a full exam and medical history and I paid the copay on my way out the door. She said she started her little practice with a few other doctors the same way, less patients, more time with patients, easier money overall, and less overhead for her. Plus she got to make her own hours and hang out with her kids whenever she wanted. I thought that was pretty fucking cool. Once I get insurance I’ll see if I can use her as my primary.
Lauren:
I am glad you found a doctor you like who had the time to spend with you, and who took a history, as every doctor knows they are supposed to do.
I think many doctors don’t give patients the time because they don’t have the time. You will find a lot of primary care physicians complain about this very thing. There is an enormous amount of job dissatisfaction in primary care in particular, because the specialty that was supposed to be about building a relationship with patients, is becoming increasingly less so due to the increasing demands of the job and higher patient loads.
Medicine is like every profession, there are good workers and bad workers. I think a lot of us assume that the nature of the profession of medicine dictates that all doctors must be good workers. That just isn’t the case.
You would also be pleased to know that medical education is changing a great deal and giving more attention to communication skills and empathy with patients.
Oh, one small piece of HUHO type advice: always ask what the differential diagnosis is. I had a nasty, nasty eye infection at one point in college.
The doctor: “Oh, it’s probably viral conjuctivitis.”
Me: “Probably?”
Doc: “Oh, it could be one other thing.”
Me: “Um…and what might that be?”
Doc looks extremely embarrassed. “Optical chlamydia.”
Gosh, I’m really lucky to have literally “stumbled” on two (i think) fantastic doctors. See, I get sick twice a year, without fail, in the spring and the fall. A sinus infection and an ear infection. Every year, since I was like 5. It has something to do with allergies but nobody can figure out how to prevent them. So anyway, I quit the university (where at least i had the student health center to fall back on), and was without either health insurance or a lot of extra cash, and August rolls around. To make a long story short, it gets to the point where I can no longer breathe, and my ear hurts so bad that I can’t sleep, so I called around and finally found a doctor who would charge me only $80 as a new patient, as compared to the $200 that I was quoted at the other places. I was able to get an appointment for the same day, I had literally no wait, they took a full history, and when the doctor found out that this was a recurring problem for me, he actually asked me what had been tried, what worked, and what didn’t. When I told him I didn’t have insurance so I needed inexpensive prescriptions, he prescribed an inexpensive antibiotic, recommended an OTC decongestant that actually worked, and gave me four one-ounce samples of a name-brand steroid nasal spray that worked wonders. (And I asked my pharmacist for future reference. Had I needed to pay out of pocket, it would have cost me $40 an ounce!) And, to top it all off, when I went to pay, they only charged me $45 instead of the $80 I was quoted. I was told that “Dr. M. doesn’t think it’s right that health insurance is so outrageously expensive.” When I went back the following spring and did have health insurance, he did prescribe a better antibiotic, which worked in fewer doses, but he still told me to take the same OTC decongestant and still gave me samples of the nasal spray. He even gave me extras and told me to start taking it as soon as I feel any symptoms coming on so maybe I won’t have to come see him next time. I also found my gyn the same way, when PP couldn’t get me in when I needed to get in. She’s great, and spends a whole lot of time with you!
Lauren -
If this clinic is part of a larger company you could definitely call and ask who to speak to regarding the quality of care issues you experienced. Our company takes patient complaints regarding clinical staff very seriously -they are big red flag highly sensitive disputes that go up to our Legal/Compliance executives. At the minimum it puts a 30-day hold on the patient’s bill while the matter is being researched…
What JenM said. Complain. Hell, post the clinic’s and doctor’s name. Bad professionals get away with it because people shrug and say “what can you do”, and they aren’t called to task.
Yah, I agree with writing a letter of complaint. I’ve gotten big on doing such things, and it is true that sometimes I’ve been ignored; it is also true that sometimes the problem has been negotiated and solved. So give it a try… I generally write strong but polite letters in which I assume that generally the person in question is better behaved, but in my case there was an issue, and the parental tone seems to really get action.
We need a “Rate My Doctors” type site following the Rate My Professors model.
Sorry to hear about your experience, Lauren.