JG writes:
After a few years of pain in my lower back and hips, and a long history of mobility oddities, health issues, and struggle with weight, I was referred to a Pain specialist, in the hopes he could pinpoint the cause, and suggest treatment and pain management techniques so I could return to being active.
On Monday, I woke up many hours before my appointment, and left plenty of extra time to get to the clinic. This extra time was wasted, as I went to the wrong medical center (multiple clinics in town share the same name). I’ve been to both in recent months, and I became confused. I called right away, and told the 1st receptionist what happened. She said she’d page the doctor to see if he’d still see me, and in the meantime, I headed over. The two clinics are near each other, it was easy to turn around, get back on a bus, and walk the briskest pace I could to make the last several blocks. I showed up 20 minutes late. The 2nd receptionist said “Did you get the reminder phone call about the time for your appointment today?” I had. The 1st receptionist said “This is the woman who just called!” The 2nd receptionist “Oh. It’s your first time here. I see.” I don’t find it entirely implausible that people make this mistake once in a while, I felt rather frustrated by the brusque response.
While I wait for the doctor, I finish up notes on the illustrations I’d made of myself and areas of pain and how the correlate to various activities – I brought them as suggested by my primary care physician.
I lost about 28 minutes of the appointment, so I understand a rushed exam and a lack of patience. What I do not expect is that he asks me questions, and never lets me answer a single one, he cuts me off every single time. He doesn’t have my medical history or records other than the form I filled out as a first time patient. He glances at the illustrations over my shoulder but won’t look at the documentation of pain and what it correlates to (or take them to review later). He pokes exceedingly hard in places he’s examining, and seems surprised that I can’t tell what hurts anymore (The physical therapist I’d seen with her full weight on an elbow never hurt like his prodding did.). He further ignores me repeated statements of “But that is not where it hurts!” It still hurt to touch the areas he pressed hours later.
He said I have “Degenerative Disc Disease” and “Sacroiliac” problems. Now, with him not having looked at the x-rays, or even talking to me about what the problem is with the pain (or where the pain is!), how can he diagnose so quickly? Then he tells me stuff I already knew (based on my PCP and PT doctors, and research), no surgery will fix it, no medication will help, Physical Therapy is the only thing that’ll do it (and apparently, I can do it myself with some stretching, and maybe a home TENS unit, according to this new doctor – So what, how dare I waste his time when a home remedy is all I need?), and says I don’t need an MRI or other exam because there’s no nerve damage (I have no reflexes in my right leg, and both legs will go limp periodically when I walk, my hips experience pins and needles… that’s not nerve related?). He suggests loosing weight, I give a somewhat spotty response since he keeps interrupting me. Then he gets on the phone, dictates over several minutes everything I wrote on the form, his evaluation, and a request to send it back to my doctor.
Then the real trouble starts. He gets off the phone and says I need to loose weight, it’s all about expending more calories than I take in (I would LOVE to expend calories, that’s why I’m here, sir!). I tell him I’ve been to 2 nutritionists, and that eating well is too expensive when I’m out of work. He repeats himself before I finish. I remind him of my history of PCOS – and he says “Oh, well, you could eat a matchstick and gain weight!” and repeats the other part again. I tell him mobility is a better help to me. Then he suggests starvation. I point out that I’ve done that too [1], as a precursor to a specific diet and exercise plan and it resulted in 60lbs. of weight loss, but that mobility was key. I try to explain to him that when I’m mobile, I can and do loose weight. He then says I should consider starving myself to get the weight off.
His expression, his attitude, it’s like he seemed to think I only needed to be confronted about being fat, or like none of the dozens of doctors I’ve seen in my adult life ever told me I was fat and that I should do something about it, or like he’s the first person to tell me my weight is killing me. He acted like I never before heard about weight loss options, and really, if I would just consider not gorging myself I’d be perfectly healthy!
[1]When I was 19, and living with my ex-husband in our first apartment hundreds of miles away from everyone, I ended up starving, and lost 25lbs. It wasn’t on purpose, it wasn’t instant, we had no money, and finally after a week without eating anything but 3 oranges I was eating skin from the sides of my fingernails without even noticing it. In 1999, I discovered the low-carb diet as a treatment for PCOS, and against the advice of everything I’d read, I ate about half of the minimum, starving myself for an ugly month full of hysteria, panic attacks, and extreme fatigue. Since then, having developed difficulties with hypoglycemia, and putting on much more weight than I had back then (recent surgery recovery tells me if I get weak, I’m going to seriously injure myself the first time I fall down, trip, or pass out from dizziness because the weight will get in the way), and the mental side effects (I would probably need a suicide watch at some point, I was quite suicidal during the second starvation episode), I can’t imagine this is even remotely safe to do without immediate medical supervision. It seemed highly inappropriate for him to suggest a dangerous home remedy without having looked at any test or evidence, or consulting my medical history. It also seems inappropriate for him to offer this advice outside of his specialty and experience.
On Tuesday I was in more pain than I’d had in weeks, and on Wed. I was in more pain than I had been in for several MONTHS, I had clear swelling around the spots around my spine and neck where he pressed so hard, and spots that feel like lumps in the tissue. Touching the area is still quite painful. I feel it bears repeating, even with the most severe pressing, exploration and deep tissue work done by my physical therapist, I never left her office injured. I am currently awaiting a response from my PCP, I expect I will file a grievance with the clinic.
First, Do No Harm 