Orthopedic visit.

[rivka]

I saw the orthopedist today for my back and side pain.

The tone for the visit was set by the nurse, who marched into the exam room and announced, "If you can't have X-rays, I can't imagine what the doctor is going to be able to do for you."

Holding my chart in her hand, she asked me about my surgical history. I mentioned the two most recent and relevant ones - the back surgery which is probably responsible for the pain, and the total hip replacement - and told her that the rest of the surgeries should be listed in my record. She asked me to list them all again. Then the Physician Assistant came in and asked me to list all my surgeries again. (I've had eleven, so it's not a petty requirement.)

The PA had a very particular way that she wanted to take my HPI (history of present illness). If I didn't answer in exactly the right way, she interrupted me. For example:

PA: Over time, has the pain gotten worse, stayed the same, or gotten better?
rivka: Well, the thing is, it's not constant - there are various factors that make it worse or better, and...
PA: [interrupting, and using a tone suitable for interrogating a three year old.] Has the pain gotten worse?
rivka: No.
PA: Has it gotten better?
rivka: No.
PA: [in tones of great satisfaction] It has stayed the same. Now, are there any factors that make it better or worse?

Both the nurse and the PA seemed utterly nonplussed by the fact that I'm not taking any medication for my pain. Both responded to that statement with facial expressions and body language strongly implying that I was wasting their time.

The orthopedist and I had a brief pleasant moment in which we established that he'd done his residency at the same hospital where I had my back surgery, working under my surgeon. We apparently missed each other's tenure at the hospital by a few months. Then things went downhill fast.

He assured me, condescendingly, that all pregnant women have backaches. I started to say "I don't think this is a normal pregnancy backache, because-" and he interrupted me to say "Oh, there's no such thing as a "normal" pregnancy backache. Women tell me they can't sit, they can't walk, they can't stand..." He did eventually allow as how my scar tissue was probably involved in the pain, which was big of him. And he told me that, after this many years, the odds of anything being wrong with the hardware in my back are infintessimally small. I wasn't really worried about that, but I suppose it's good to know.

He did write me a prescription for physical therapy, saying that massage, ultrasound, or special exercises might help. Which is what my midwife thought, and it's all I really wanted.

My records from the hospital where I had my back surgery hadn't arrived. I told him I was disappointed, because I was hoping he could tell me the exact location of my spinal fusion so that I could discuss my prospects of spinal anesthesia during delivery with an anesthesiologist.

He said, "No anesthesiologist will do an epidural for a woman with scoliosis."

I started to explain that I'm not planning to have an epidural, but that I would want spinal anesthesia if a C-section were required. He interrupted me to tell me, again condescendingly, that women have been giving birth without epidurals for thousands of years. I explained again that I wanted to know if I could have a spinal for a C-section, even though at this point we were veering well outside "any of his business" territory. He told me that, with my combination of scoliosis and prior back surgery, I was not a candidate for spinal anesthesia. Then he reassured me that I might not need a C-section.

Not having learned my lesson yet, I told him about my osteotomy history. And he completely switched gears. "Well, with a pelvic osteotomy, then in this litigious society - not that I'm saying that you're litigious - it's extremely unlikely that you'll be permitted to deliver vaginally."

I interrupted him this time to say, "Yes, that's why I'm delivering with a midwife." And I went on to tell him that I'd researched the medical literature myself, and understood perfectly well what the C-section rates were for women who had my specific procedure. You'd think that would shut him up, but he had to have the last word by implying that the C-section rates were higher than I thought.

At least I made it all the way home before I started sobbing.

Honestly, I knew that he wasn't going to be able to give me a definitive diagnosis without X-rays. I knew that most of his pain relief armamentarium was going to be off-limits for me. I wanted an educated guess and a prescription for physical therapy, and that's more or less what I got. But on a personal level, the treatment I got was awful. None of them listened to me. None of them showed me the slightest respect.

I bet I could have talked my primary care doctor into prescribing physical therapy, and avoided the whole thing. At least she likes me.

Comments

[mactavish.livejournal.com]

Well, what a big poo. Oddly, of all the doctors I've seen, the orthopedists have been the most robotic, have treated me least like a human who has a clue what's going on. I do know one nice orthopedist, but she's not my doctor, and I don't know how she is with patients. I wonder if there's something about certain personalities that drives people to the specialty.

Sounds like this one treated you (and probably treats everyone else) like he's the Expert and they're all Fussy Peons. I'm sorry. :(

[rivka.livejournal.com]

Oddly, of all the doctors I've seen, the orthopedists have been the most robotic, have treated me least like a human who has a clue what's going on. [...] I wonder if there's something about certain personalities that drives people to the specialty.

Orthopedics is a surgical specialty, and I've definitely heard that some people choose ortho because they're not enthusiastic about dealing with conscious patients.

I remember when I saw a rheumatologist because I'd gotten some weird lab results. I was struck with how attentively he asked about every symptom I'd endorsed, and how careful and thorough his exam was. I'd never experienced a visit quite like that before. When I told my sister (the primary care doc) about it, she said, "Yeah, rheumatologists really pride themselves on their exam skills."

I hadn't thought that specialties would differ in how they valued that sort of thing.

[anisoptera.livejournal.com]

That is awful, really awful.

I wonder if a physiatrist would be more helpful.

[jonquil.livejournal.com]

Son of a BITCH.

Clearly a member of the "Kindly Call Me God" squad.

I hate this doctor, and I devoutly hope you never have to see him again. There are too many of his kind in the profession.

[rivka.livejournal.com]

I live in a large city. If I ever need to see a spine specialist before, I've got plenty of options.

Fortunately for him.

ICK!

[writingortyping.livejournal.com]

What a terrible thing to have to go through!

Why is it that so many physicians seem to think that condescension and brushing-off of problems will just make them go away? Thank goodness you have the smarts and the experience to get the facts and soldier on with this alleged "care giver." My grandmother had repeated ear and headaches brushed off by her doc who just told her it was one of the consequences of age. Both her eardrums ruptured in his waiting room.

People know their bodies much better than a lot of docs give them credit for, in my opinion.

Re: ICK!

[nancylebov.livejournal.com]

I've wondered whether extended sleep deficiency during medical training can cause brain damage.

[selki.livejournal.com]

What awful, destructive people.

I'm glad you got out of there with your 'scrip.

[kightp.livejournal.com]

Oh, sweetie, what an awful way to treat anybody (much less a pregnant woman! Sheesh!)

Did your PCP refer you to this guy? If so, let her know what a jerk he was.

At least you got your PT prescription. Now you never have to see this guy again (me, I'd be tempted to write and tell him why, but I'm cranky that way).

[johnpalmer.livejournal.com]

re: informing the doctor why, I'd let curiousangel do it, simply to satisfy the normal guy desire to rip apart anyone who is nasty to one's beloved in such a situation. Also, it's a lot easier to be angry on another person's behalf than on one's own.

But word should be spread around. Especially given the situation.

You know, it's one of those things... doctors aren't really *doing* stuff, for the most part. The body does stuff. Except for surgery and similar stuff, the doctor provides information, and support, and then should get the hell out of the way. It seems like this doctor was failing on the first two, and, if he's got a sense of self preservation, bloody well better do the third.

[beckyzoole.livejournal.com]

Most physicians are not used to dealing with intelligent patients who are truly involved in their own healthcare. They don't know how to handle them, and so, I think, they pretend they don't exist.

My SO bbwoof is currently in the hospital for acute idiopathic pancreatitis (his pancreas is inflamed for no apparent reason). Two days ago I was in the room when the resident stopped in to check on him. I've been researching pancreatitis, so I asked her several questions about his bloodwork and the location of the inflammation. She answered, and asked me if I was a doctor? She was quite taken aback to learn that I was just an intelligent concerned computer geek, and left the room with little further conversation....

[kate_nepveu]

It's like dealing with tech support. "No, I searched the hard drive for it. Yes, I know how to search. I know you get a lot of people who think they know what they're doing and don't, but I really do! Honest!"

Which is no excuse, absolutely none, for failing to listen and for being assholes. But I bet it's the same mindset.

[edschweppe.livejournal.com]

Oh, criminy. What a band of incompetent nitwits. (Maybe they know the mechanics of medicine, but it sounds like the lot of them flunked Bedside Manner 101.)

At least I made it all the way home before I started sobbing.
First point: You did absolutely nothing wrong. In fact, I think you handled things wonderfully.
Second point: They were the ones who were screwed up, not you. (I think you know this.)
Third point: You really deserve self-control points for not shooting those pinheads.

I really hope that there's some way you can make sure never to go back to that office. Or at least some way to file a formal complaint with your insurance company, or the state board of registration.

[rivka.livejournal.com]

First point: You did absolutely nothing wrong. In fact, I think you handled things wonderfully.
Second point: They were the ones who were screwed up, not you. (I think you know this.)

To put this in perspective: I'm pregnant. I'm awash with hormones. I cry at everything.

Yes, I do know all of the things you said. Still, it never hurts to have them repeated.

[cheshyre]

Dear gd!

If I were you, I'd report these folks to whatever medical board so other less assertive patients don't get victimized.

women have been giving birth without epidurals for thousands of years
Yeah, and for thousands of years, dentists pulled teeth without anesthetic, too. How do you want that root canal!?

[mactavish.livejournal.com]

and for thousands of years, dentists pulled teeth without anesthetic, too

And she was asking about c-sections, not vaginal birth, in that context! He wants abdominal surgery "naturally"?

[jinian.livejournal.com]

What asshats. I'm sorry the visit was so frustrating, and I think it's great that you were persistent enough to get what you needed from them. You should definitely write a letter, to someone in charge of these twits if possible (and tell us all their names maximally publicly, too).

[papersky.livejournal.com]

Ah. Doctors. Yes.

That's why I never want to go and see them, especially when I'm not feeling very well.

I hope the physio helps.

I'm really sorry you had to endure that. I'm not at all surprised, as that's mostly been my experience, but I'm really sorry anyway.

[rivka.livejournal.com]

Ah. Doctors. Yes.

I spent much of the drive home chanting, through clenched teeth, "This is why I'm using a midwife instead of an M.D."

Because I just can't imagine having an experience like that every four weeks when I go in for prenatal care.

[minnaleigh.livejournal.com]

I'm sorry you had such a horrid experience. That feeling of not being listened to is really the worst thing. *hug*

[rickvs.livejournal.com]

My wife finds it occasionally useful, when she's being condescended to by medical folks, to insist that they address her as "Doctor". Depending on how you're wired, you might also find that approach satisfying -- it at least seems to wake them up a bit. Sorry you had to deal with those wankers.

[lerryn.livejournal.com]

That sounds a lot like the kind of crap aladriana has had to put up with in dealing with fibromyalgia. I'm sorry you ran into it too. It seems like a fairly large percentage of doctors have their memorized speech and don't care if what you have to say is completely unrelated to it.

[ckd]

I wish you hadn't had that experience; nobody should have to put up with being treated like a robotic diagnostic test dummy. That just makes me want to go stabbitystabbitystabbity. Seriously, just reading your description is pissing me off (at them, not you); I honestly envy your self-control in not causing them all some form of bodily harm and then asking them if the pain is "getting better, getting worse, or staying the same" as they writhe on the floor.

I hope that your physical therapy goes well and that the therapist is helpful and a good listener. (All of the ones I've ever known have been, and you deserve the best.)

[saoba.livejournal.com]

My first thought, as I sit here vibrating with fury, is that I wish I'd been there with you. Wearing my Official Stompy Boots of Butt Kickery.

Gah. One of the reasons I do labor coaching is because of medical twits like these.

A round of hugs to you and Misha to share amongst yourselves.

If Misha wants to go ballaistic on these folks, I'd let him. Whoever referred you to this jerk needs to be informed of the poor quality of care you received.

My final thought is that I really REALLY wish I'd been there in my Official Stompy Boots of Butt Kickery.

[minnehaha.livejournal.com]

Sounds awful. Patients who "know stuff" are often problems for doctors, because they, um, know stuff. Sad the the profession can't deal with knowledgeable people very well.

B

[rivka.livejournal.com]

One thing that I absolutely adore about my midwives is that they love having me know things. They've said point-blank that "we don't want you to be a 'good patient.' "

My primary care doctor is pretty good about respecting what I know, listening to me, and answering my questions. It's why she's my primary care doctor.

[ex-serenejo.livejournal.com]

Oh, yuck yuck yuck! If you have the emotional energy for a consumer letter, this would be one I would encourage you to write. Bleah.

[tsjafo.livejournal.com]

I saw a sign once in a hospital that said "They don't care how much you know until they know how much you care." I think that should be posted at every hospital and clinic as a reminder to the staff.

I tend to get tongue-tied around my doctor (and I have no idea why. I'm 50 years old, I'm a veteran, you'd think nothing would phase me) so I write things down and take them with me. Like all my meds. Maybe you could come up with a history, print it out and take it with you each time you go to the doctor. When they ask for a history, hand it to 'em.

Maybe you can take someone with you. When I get really tongue-tied, when I can't articulate what exactly I'm feeling, I take my wife with me. I can talk to her and she can speak for me when I can't. And I speak for her when she can't.

I hope you don't have to put up with this kind of treatment again, and I hope you feel better soon.

[zeldajean.livejournal.com]

I'm a veteran

Thanks.

[porcinea.livejournal.com]

Fuckwads!!

*hugs*

[pnh.livejournal.com]

Jesus H. Christ.

[janetmiles.livejournal.com]

He assured me, condescendingly, that all pregnant women have backaches. I started to say "I don't think this is a normal pregnancy backache, because-" and he interrupted me to say "Oh, there's no such thing as a "normal" pregnancy backache. Women tell me they can't sit, they can't walk, they can't stand..."

Oh, for fuck's sake. He's obviously related to the obstetrician my mother saw when she was pregnant with Cris. According to her, the conversation (every four weeks) went like this:

Mom: I have back pain.

Obstetrician: All pregnant women have back pain, Karen.

Mom: I didn't have pain like this when I was pregnant with Janet.

OB: Yes, you did, dear, you just don't remember it. All pregnant women have back pain.

The conversation, after delivery, went like this:

OB: Back pain all gone, right, dear?

Mom: NO.

OB: Oh.

Turned out she had a slipped disc, and spent a few months sleeping in traction.

Beavises, all of them. (I do not say assholes; the asshole serves a useful function.)

[msagara.livejournal.com]

I had some of this problem when I was in the hospital with my youngest son. The doctors asked questions, but answered none; there reply to my questions -- a result of theirs -- was "It's nothing."

On the last day, I kind of flipped a gasket (I was there for 9 days) and essentially said, "If all of these questions are being asked for No Damn Reason, then guess bloody what? I'm not answering any more of them. I'm tired of being treated like a moron. I'm not willing to participate in your god@#$ research project, and, at the moment, you can all go to hell."

My favourite? The neurologist. When I started to ask a couple of relevant questions about their treatment plans, she asked me why I was asking, and where I'd gotten my information from. I said, "As I've been told so little, I've been doing some research on the internet."

She said, with obvious contempt, "Oh, the internet."

And I said, "If you think the American Academy of Neurology is comprised of quacks and loons, do please enlighten me, and I'll stop reading."

So she shut up.

But my pediatrician, who I adore, and who works out of Sick Kids, said that it's really, really rare for people to actually do any research, or to be knowledgeable about medical things; that usually, when things happen to their small children that they don't understand, they fly into a blind, hysterical panic and that doctors, like people, react to blind hysteria in different ways.

I'm really sorry, though; it's awful.

[jerusha.livejournal.com]

She said, with obvious contempt, "Oh, the internet."

And I said, "If you think the American Academy of Neurology is comprised of quacks and loons, do please enlighten me, and I'll stop reading."

So she shut up.


<applauds wildly>

[minnehaha.livejournal.com]

Moving past this dreadful experience with these horrible people, when you get to the physical therapist, ask if trigger point massage would be useful. I just keep thinking it will help you and lessen your pain.

K.

[oursin.livejournal.com]

women have been giving birth without epidurals for thousands of years

And can he also parrot out the corollary to this, the terrifying levels of mortality in childbirth during those years, not just from the obvious things that can go wrong like haemorrhaging or infection, but from exhaustion and shock? A little learning is a dangerous thing. Words fail me. Letting people into medical school just because they have high grades in the requisite subjects is really not the way to recruit for a 'caring' profession, but that's the way it goes in a lot of countries.