Last week a patient broke down in tears during her appointment.
She was in the middle of a massive pain flare in her back, but she wasn’t crying about the level of discomfort she was experiencing.
It was her third visit with me and we’d made some progress with her pain but she’d overdone it and her symptoms had escalated again.
She was understandably frustrated, but there was more to it -- she was afraid.
Fear and anxiety are common when chronic conditions flare and we can’t seem to get a handle on them.
I thought this was one of those times.
Then she told me the story of when she was originally treated for the pain.
She was in her 20s when she had an injury that created unbearable agony in her low back.
She went through the gamut of Western medical diagnosis and imaging.
She had surgery.
After recovery, she was still in so much pain she could barely get out of bed.
She returned numerous times to her doctor who told her there was nothing wrong with her.
He said it was all in her head and that she needed to see a psychiatrist.
A note was put in her chart citing malingering, or faking her illness and still seeking treatment.
As a result, all other doctors within her insurance system didn’t take her seriously when she sought their help.
When she told me all of this I realized that she wasn’t afraid of her pain. She was afraid that I wouldn’t believe her.
Medicine has a long history of not taking women’s pain or health complaints seriously that still persists today.
Black people come face to face with completely false stereotypes that originated in the 19th century during their visits and Black women are consistently not believed when they report pain.
I’ve heard more stories than I can count from other patients of mine not being taken seriously.
One had three strikes against her: she was young, female, and had a larger body type.
Every practitioner she saw told her that she just needed to lose weight or that she was too young to have something so severe. She left with no treatment recommendations each time.
Another person I know was told that her anxiety around her chronic pain couldn’t be addressed because it was just “part of her personality”.
Let me straighten something out right now: The problem is not you.
You are not difficult, you just need to be listened to.
And there aren’t a lot of doctors in the conventional medical world that are willing or able to do that.
Many face extraordinary time pressures with insurance reimbursements designed around 15 minute increments.
How is anyone supposed to accomplish anything beyond writing a prescription when visits are so limited?
Payment is much higher for procedures than it is for patient counseling and education so doctors are incentivized to ratchet up the interventions and treatments instead of just talking to you.
Doctors in hospitals often have their hands tied by hospital administrators who care more about the bottom line than patients.
I’m not making excuses, but I do want to highlight just how broken our medical system is when people who want to help and serve others aren’t allowed to do so. It’s soul crushing for both doctor and patient.
There are two things we as physicians can always offer our patients, regardless of the system we work in: empathy and humility.
Most simply, start by believing people.
If people are hurting, validate their pain.
Listen to the person in front of you instead of basing the entirety of your judgment of their condition on tests and examinations.
There’s plenty about the body that we still don’t understand and modern medical diagnostic tools are not the end all be all to understanding what’s going on internally.
Tests can offer insights, but they don’t represent the whole person in your treatment room asking for your help.
Realize that your patient may have been afraid to bring their health issues to your attention and honor that vulnerability.
It takes courage to ask for help and that effort should be received gently and compassionately.
Next, exercise humility.
Get comfortable with saying, “I don’t know.”
STOP blaming your patient.
If someone doesn’t check all of your diagnostic boxes for a condition, recognize that their symptoms still mean something and need to be addressed.
The lens of modern Western medicine is narrow and focused on well progressed conditions.
A myriad of other modalities and medicines exist that are meant to prevent illness and help people heal when they are in a functional state of imbalance, not yet a full blown disease.
Consider referrals to naturopaths, mental health professionals, chiropractors, acupuncturists, massage therapists, physical therapists, Reiki practitioners, and more.
If you don’t know anything about these modalities, educate yourself or reach out.
Trust me, I would love to know open-minded MDs and would happily tell you all about how I view the body and how my medicine could complement yours.
Look beyond pills and surgery.
Offer something greater to your patients by being humble enough to say, “I’m not sure, but let’s work through this together.”
In my experience, people aren’t upset that you don’t know, they’re grateful that you’ve admitted your limits and are open to walking the path with them.
Dear patients, I’m sorry if you’ve had any of these experiences.
If you’ve felt hurt, judged, shamed, or avoided getting care because you were afraid of what might happen or that it would be pointless.
Navigating modern medicine puts an immense burden on you.
Finding a practitioner who will listen and not be frustrated if you ask to be educated about the treatment they are recommending is difficult.
Many of my patients have great anxiety if they have to enter into the western medical system. They expect to be steamrolled, disregarded, or at the worst, ridiculed.
Going in to a medical appointment can feel like the beginning of a battle. You must educate yourself and be able to advocate for yourself. And I gotta say, that’s pretty hard to do if you’re sick or in pain.
Ask questions. Like, an annoying amount, until you have all of your answers.
The lack of education around major health decisions, procedures, and drugs is appalling. You deserve to be informed so you can choose the best option FOR YOU, not the convenience of your doctor or insurance system. You deserve to consent to everything and not be rushed into decisions.
This is YOUR body, YOUR health, and YOUR life. You have to live in it every day and you deserve to know potential side effects, recovery, long term impacts, and anything else you want to know.
If you aren’t sure about what you’ve heard, get a second opinion. Try out natural medicine; we have a lot to offer!
Find someone who listens to you and makes you feel safe and heard. Look for empathy and humility. Find someone you don’t have to battle with constantly.
You deserve to be believed. You deserve to be listened to. You deserve better.