I am at the doctor’s office because my shoulder hurts. I rarely make these appointments because I know I’m going to be probed with the same tired questions that have nothing to do with my pain.
“You’re here for a wellness check.”
“No. I’m here because my shoulder hurts. You’re going to use my visit to go through your usual list again, aren’t you.” I say this with a little grin, trying to keep the interaction upbeat.
He’s looking deeply into his computer. The essential me is not in there. “It’s been well over a year since you had a physical. When was your last pap smear?”
“Oh. Probably somewhere in the 80’s.” And I tell you that every time I come in.
“Have you had a mammogram recently?”
“No. I think the last one of those was in the 90’s.” And I tell you that every time I come in.
“Women need to keep having annual mammograms through their 70’s. We’ll do a breast exam while you’re here. Have you done the colonoscopy?”
“No.”
“The home fecal occult test?”
“No.”
“How have you been feeling?”
“My shoulder hurts.”
“I’m going to give you the home test.” Insert here a demo of how to place the paper over the toilet seat, probe the stool with the given probe and seal it back in the vial.
“I see you recently sent in a request for prescription refills. You’ll need to come in for a fasting blood test so we can check everything before we do those prescriptions. You can turn in your stool sample when you come back to the lab for blood work.”
The prescription refills I requested are for asthma. If I don’t get them, I’ll be in the ER within a week, two at the most. But my asthma is going to be held hostage to a blood test required for a thyroid medicine I don’t need refilled at the moment. Meanwhile, my hurting shoulder seems to be way off the radar.
“It would be good if you could lose a few pounds. Your records say you have a very good diet?”
“Yes we do.” We are fortunate to be able to afford organic produce. Plus I love to cook. I make meals as clean and healthy as I can.
“How about exercise?”
I start to get testy. Not only is the fact that my shoulder hurts being totally ignored, but my history as a patient is nowhere in that question. I have severe osteoarthritis. I’ve been through extensive physical therapy to shore up my joints enough to continue doing activities I love. Everyone in this clinic should know that.
“Look,” I begin. “I am unwilling to answer any more questions until you look at this shoulder that is in pain. We have discussed my position on each of those other issues several times. Could you please look at my shoulder?”
A visit to the doctor’s office often results in feeling powerless. We are on such unequal footing there! Doctors have all the medical knowledge to tell us what needs to be done for certain diseases and conditions. With the clout of the entire profession behind them, they are supposed to hound us to have certain screenings that might prevent serious illness. Only a primary care physician can write prescriptions, order physical therapy and send you to a specialist as needed.
On the other hand, you are the only one who knows your body and your wishes for treatment. That is your power. One way to equalize this inherently unequal relationship between doctor and patient is to view yourself as the advocate for your body.
Imagine that a real, live person comes to the doctor’s office with you. That person is the body’s advocate, someone who will say, “Excuse me for interrupting these questions. I want you to consider the pain in my shoulder first. I’ll help you with the rest afterward.”
Or, “Hold on, please. I feel as if my needs aren’t being considered. Would you please address my concerns about my shoulder? Then we can talk about your questions.”
Doctors need to ask certain questions in order to be paid for their services. It’s part of a medical system focused on actively promoting health, rather than passively waiting for patients to come in with issues that could have been dealt with more effectively at an earlier stage.
Fine. But patients need to make their own voices heard in the doctor’s office. Being civil about having your own voice in matters concerning your body will be much more effective than being antagonistic, such as saying, “I’m not answering your stupid questions until you look at my shoulder!” Which is what I wanted to say.
If your doctor is recommending screenings and you do not see the value of those tests, say so. Study the issue on your own. Read about it in reliable sources. Give the matter careful thought so that you are clear about what your position is and why you feel that way. Then be willing to discuss the issue with your doctor, the same way an advocate for your body and for your wishes would discuss them.
One way to make sure that conversations don’t happen over and over, each time you see your doctor, is to ask that notes be written right into your file indicating that the topics have been discussed and your choices have been made clear. Another solution is to provide that documentation yourself and then submit the document to the clinic to be included in your files.
Even in the doctor’s office we need to practice living as equals.
