Medicine Schmedicine

At lunch today, my dad suggested that perhaps my file at the University Health Center is flagged “Pain in the [deleted]”. If it wasn’t before this afternoon, it probably is now.

After all, my real Doctor’s office (where I see my Physician Assistants) has a slightly nicer flag that probably means the same thing: “Do not schedule for appointments less than 30 minutes long.” I saw the flag once, a giant yellow banner at the top of my computerized information. It lets the scheduler (and the PA’s) know that I’m going to be an involved patient.

And I am an involved patient. I consider myself to be the head of my health care team–whatever the physician may think of himself. No one else knows my body, my mind, or my medical history as well as I do. No one else knows all the information (and unfortunately, too many doctors would prefer I not give them all the information.)

And since I’m the one who knows me the best, I deserve to be heard in the doctor’s office.

Unfortunately, that’s not the way doctors always see things. Too often, I see a physician’s eyes glaze over when I start detailing my past medical history and current diagnoses. Too often, I get brush-offs when I raise a question about something the doctor tells me.

I probably don’t have to be as upset as I am about today’s visit. After all, he’s going to run the blood work I wanted him to do. I would have been happy if he’d just run the blood work and said “Let’s wait for results before I tell you anything else.” So why should I be so upset that he did what I wanted and then gave me all sorts of “free” advice.

He was just being a University Health Center- type doctor, giving his patient what he thought she wanted to hear. “Let me give you some self-help ideas to deal with your ‘dandruff’, ‘sleep problems’, ‘heartburn’, and dry skin.” What he didn’t realize or bother to find out was that I already know how to handle dandruff, sleep problems, dry skin, and heartburn. I also already know that I don’t have sleep problems or heartburn–and highly doubt that I have dandruff.

I say I’m fatigued and tell him that I haven’t had a consistent sleep pattern “since this started”. So he tells me to establish a consistent sleep pattern. He gives me all sorts of advice to help me sleep better. What he didn’t bother to do was give any answers for the problem I was there for–extraordinary fatigue that is keeping me from being able to perform my daily activities (working a job, keeping up with the laundry, and washing the dishes) DESPITE getting 7-8 hours of sleep every night.

I tell him that I’m having chest pain–which I’ve had before. I tell him that the chest pain is a stress response–I know it’s not heart problems (because I had a complete heart work up last year and got a clean bill of heart health). I tell him that I’m worried because I don’t think I’m experiencing enough stress to warrant this extreme physiological stress response. So he tells me I have heartburn and gives me advice for managing heartburn.

I brought up the dry skin, mainly to make sure he knows I need to have my thyroid checked. I point out that the dry skin has worsened even as I quit the job that had me washing my hands with drying soap several times an hour. He tells me this winter’s been bad for skin and that I should wear gloves when I wash my dishes. (Yes, I know. But did you miss the part where I said I’m too tired to keep up with the dishes?)

I don’t know why I brought up the itchy scalp stuff. Probably because it hasn’t responded to dandruff shampoo–even though I was leaving the shampoo on for quite a while (10-15 minutes a pop). Probably because my two PA roommates think it’s psoriasis. Probably cause I wanted to make sure I didn’t miss anything that could be potentially useful in making a diagnosis of my REAL problem. But the doctor took it as a serious problem and paid no attention to my assertion that dandruff shampoo had no effect on the itchy stuff on my scalp. He insisted that I had dandruff–and that I ought to wash my hair with dandruff shampoo once a week for (get this) 15 minutes before rinsing it off. Imagine that!

I got what I wanted–an order for a complete blood work-up including TSH (thyroid stimulating hormone). I just wish I didn’t have to go through the frustration of THAT to get it.

I miss my health care team. I miss my PA’s who let me tell them my whole story before they break in with questions, who tell me what they’re thinking when they’re doing their differential diagnosis, who take my questions seriously. I miss the team that already knows my meds, and understands why I’m on them. I miss how they always ask me for any last questions before I leave. I miss how they know to hand me a copy of my charts and laboratory values before I leave so I can put them in my personal medical file. I miss my pharmacists too. I miss seeing the same person every time I go to the pharmacy. I miss being able to get my prescriptions filled while I do my grocery shopping. I miss the pharmacy’s willingness to answer every question I have.

I guess I miss my Blue Cross Blue Shield insurance. Yeah, I didn’t have “free” visits to a clinic like I do with student insurance–but at least I got to see my team. I might not have the flexible scheduling of on campus health care–but at least I had confidence that my health care providers were practicing evidence based medicine. So there were more hoops to jump through back then–but at least then I was the head of my health care team. Here, at the Health Center, I’m just another dumb student who needs to use more lotion.

Medicine Schmedicine. Nothing worth stressing about, right?