Orthopedic visit.
Nov. 11th, 2004 05:38 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
rivkaI 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?
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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.
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.
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no subject
Date: 2004-11-11 03:54 pm (UTC)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.
no subject
Date: 2004-11-11 06:34 pm (UTC)Because I've always been the kind of woman who wanted men to fight her battles for her.
But even if I were, for heaven's sake, why would I want to perpetuate this doctor's misconceived notion that I didn't know what was best for myself and couldn't take care of myself, by letting someone else be my proxy in making the complaint?
no subject
Date: 2004-11-11 08:10 pm (UTC)The second part, which was supposed to be the "but, still, even though I'm just joking, think about this" point, I think it *is* easier for a second party to express how an encounter affected a person, and express it as strongly as is warranted by the situation... at least, sometimes.
I'm sorry what I was trying to say came out wrong... and sorry, again, if this came out wrong as well. I've been working hard and stressed all week, and I'm just not thinking about how to say stuff as clearly as I should be.
no subject
Date: 2004-11-12 05:41 am (UTC)I think that your stress and my over-reactive hormones probably weren't a good combination. ;-)