Of Course, It's All In Your Head!

A patient asks me:

"Doc, are you saying this is all in my head?"

The assumption behind the question: things in the mind are not real. Doctors also display this unfounded assumption. We just obscure our prejudices by using medical jargon like "supratentorial." (First reader to define Supratentorial and use it in a sentence wins Doctor D's prize of the week!)

Every illness you ever had was "all in your head." Seriously, where else could it have been? You have never felt a symptom, whether it was a broken ankle or a broken heart, that wasn't felt in your mind. Your mind is your consciousness. Every pain, cramp, anxiety, or ache is felt exclusively in the mind. Your mind is not a part of your body. Your body—as you know it—is a part of your mind.

Doctor D, has had a couple brain-dead (literally not figuratively) patients. Trust me, they never complained of anything! They never had any symptoms. They never felt bad. And their bodies didn't survive long without minds.

Many doctors hold to this absurd theory that your body is a separate entity from your mind and physicians should focus solely on the body. But the human mind keeps getting in the way and annoying these stupid doctors. Of course it does! The mind and body are completely interwoven and inseparable.

This crazy idea that the mind shouldn't interfere with the body has spread from stupid doctors and now created a stupid culture. It is tricky to actually figure out what is going on with a person because everybody now denies their mind has anything to do with their symptoms. Lots of patients refuse to answer when Doctor D asks about their feelings about their symptoms or illness. I can understand why. They're worried that Doctor D thinks they are nuts. Having a mind doesn't make you crazy, it's loosing your mind that is crazy!

So Doctor D has some ideas for how MDs and patients can overcome our anti-mind biases and improve doctor-patient relationships:

• First, doctors and patients both need to acknowledge that all symptoms are real. If you feel it in your mind then it is real—period. We don't say that happiness is "imaginary" because it is a mental state. We shouldn't say that any discomfort is imaginary. Fibromyalgia and panic attacks are just as real as pneumonia and broken bones.

• Second, doctors and patients both need to acknowledge that the mind is real and it matters. I know this sound obvious, but some doctors still think only Psychiatrists should pay any attention to patients' minds. No matter what the disease, ignoring the person to focus solely on the body will lead to disaster after disaster in medicine. Patients also need to be willing to discuss their mental attitudes and recognize that the mind plays a role in illness and healing.

• Finally, we need to understand that different symptoms need different treatments. Not every symptom needs a big work-up or a strong medicine. It is my job to help people distinguish dangerous symptoms from ones that are not. Shortness of breath that starts when your girlfriend breaks up with you merits a different work-up than shortness of breath with unilateral leg swelling and a low pulse ox. Both are real problems, but not the same problem. Understanding your mental and emotional experience of your symptoms helps me better diagnose you and avoid giving you treatments or work-ups that could cause you harm. In order to successfully negotiate these interactions a patient must trust that the doctor has taken the first and second step and isn't assuming they are crazy.

What do you think? Does it bother you when your doctor asks about your mental state when you report physical symptoms? Or does your doctor seem to be biased against the mind and imply you are crazy if you bring up your feelings? Do you think that these 3 steps can improve doctor-patient communication? Doctor D would love to hear your thoughts!

How To Speak Doctor

Question from a reader:

My heart sinks when I realize the vast difference between a detailed medical appreciation of my disease and the incredibly simplified version my doctors tell me. Do doctors feel like they are speaking baby talk to patients? Do patients ever really understand our illnesses, tests, and treatments?

First of all, any doctor who implies they have a full understanding of your body is bullshitting you! Some specialists may know a little more about a particular organ or disease, but in the end your body is a mystery and doctors are all just making educated guesses. Doctors know some useful things, but things we don't understand far outnumber the things we do.

Patients are nervous about doctors working with limited knowledge, so MDs learn to sound more knowledgeable than we really are. One of the easiest ways to sound really knowledgeable is to use a lot of technical jargon. We can really impress non-medical people by throwing out some dense multi-syllabic pseudo-Latin with a lot of acronyms mixed in. It just sounds so darn smart!

Doctors are also used to talking with each other in medical jargon and sometimes forget that patients have no idea what the heck these words mean. It's not that "MI" or "Raynaud's phenomenon" are too difficult to for you comprehend; it's just that they sound really complicated if you don't speak Physician.

If a doctor says something that makes no sense the best strategy is to frankly ask, "What does that mean?" When it comes to understanding your prognosis or making a decision it is important that you understand what is being discussed.

A wise teacher once told Doctor D, "If you think you understand something, but you can't explain it in a simple way you probably don't really understand it." This is true for medical knowledge. Your doctor should be able to explain these things in plain English when you ask for it.

Listening to a simple explanation in plain words it may become obvious that your physician doesn't fully understand everything either. Don't panic! We don't have to understand everything about a body or a disease to treat it well. We may not be good talkers, but we are great guessers!

Have you ever had a doctor that just couldn't speak simple English to explain your condition? Doctor D would love to hear your stories in the comments.