Dec 11, 2009

Is The Patient Crazy—Or The Doctor? (Friday Links)

Doctor D found a great blog by a patient with lots of physical maladies who used to be reporter for the Associated Press. Now she is "Sick Momma" and blogs on her life as a chronically ill mother and wife. As D was enjoying her blog and came across this post about some conditions he'd never heard of.

Apparently Sick Momma believes that many doctors suffer from a mental disorder which causes us to attribute symptoms we don't understand to a patient's mental state. Whatever!
Patients expressing unfamiliar complaints to their physicians often induce the "It's All In Your Head" (AIYH) or the "That's Impossible" response in doctors suffering from these behavioral problems and personality disorders.

Physicians fixated upon the metaphysical belief system of "If we don't know about it, then it doesn't exist" are suffering from a mental defect or psychological condition known as "Doctors with Unexplained Medical Beliefs": D.U.M.B.
Excuse me? I'm the doctor, so I'll decide what is a disorder and what isn't!

And I've never heard of these "behavioral disorders," which leads me to suspect they don't exist! Since I have no idea what put these crazy ideas in Sick Momma's mind, I shall diagnose her as depressed and put her on Prozac. I shall continue to add psychoactive medications until she learns not to challenge my god-complex!

Actually this is an interesting problem: What should be done about symptoms that make no sense? Lots of patients and doctors end up these situations.

The doc is thinking, "This doesn't sound like any disease I know about. All these symptoms are subjective sensations. Maybe it all is in this patient's head?"

The patient is thinking, "This doctor doesn't know what is causing my symptoms! What an ignorant doctor! If my doctor has never heard about this it must be something rare and horrible!"

It is a tricky impasse. Each can't help but have these impressions sometimes. We all want to prove we aren't ignorant or crazy, but then again we all want to be agreeable. Often these situations end up with either unnecessary antidepressants, unnecessary testing, or both.

We need better ways of discussing strange symptoms. Hence, in next week's reader question Doctor D shall provide some answers! (or perhaps some humble suggestions)
Until then, what do you think? Has a doctor ever told you your symptoms were all in your head? Have any of you healthcare providers ever had a patient who had nutty symptoms? Doctor D would love to hear your stories!


M. said...

This problem is an epidemic. Most people I know who have a chronic physical illness have first got a psychiatric diagnosis, including depression, psychosis, panic disorder, bipolar disorder, eating disorder and somatization disorder... These physical illnesses (that have eventually been diagnosed) have included e.g. epilepsy (two cases), Ehlers-Danlos syndrome, Sjögren's syndrome, adrenal insufficiency, ankylosing spondylitis (two cases) and many cases of CFS/ME.

I can't remember a single instance where any of the doctors has apologized.

Aviva said...

Whew! For a minute there reading this post, I feared I had actually offended you. :-) I'm really lucky that I've got a fabulous PCP who has never suggested I has a hypochondriac or anything else. There have been times when I've gotten despondent over my lack of a unifying diagnosis and asked her if it was all in my head. She's so awesome that she then would list all the "objective" criteria she can point to that make it clear *something* is wrong with me even if she can't say exactly what it is.

And the best part about having a good PCP is she sends me to good specialists, who have never suggested it was all in my head. I do get tired, however, of the musical (doctor) chairs I get stuck playing as they each send me off to someone else's specialty. What's up with that, Doctor D?

And thanks, btw, for the kind words. I've been reading you in The Queen of Optimism's comment sections, which led me to your blog. Nice to meetcha! :-)

Doctor D said...

Hi Avia (Sick Momma),

Nice to meetcha too! Glad you enjoyed the post.

One of my favorite things to read is blogs about patients' experiences in healthcare. Doctors and patients understanding how the other side thinks and feels is probably one of the most useful functions of the medical blogsphere. Your blog is one of my new favorites.

Your clever posts got me thinking and also inspired this week's answer post Of Course, It's All In Your Head! I would love to hear your thoughts on that one.

Welcome aboard Avia! It's good to have you here.

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