Doctors who call patients hypochondriacs are committing malpractice

There’s one question I get asked a lot: “I research my health problems on the Internet. Am I a hypochondriac?”

First, we should ban that word when talking about ourselves. No one wants to be called that, and doctors who use that word are committing malpractice. Everyone has some range of complaints and worries in life, often physical and mental together, and this is our job as doctors: to hear them out. I firmly believe that no complaint is illegitimate.

Nor, for that matter, is looking stuff up on the Internet a problem. Given that the advice proffered by doctors is most often not consonant with the scientific evidence (to quote this much-cited paper, “Even those physicians who are most enthusiastic about EBM (evidence-based medicine) rely more on traditional information sources than EBM-related sources”), I doubt that seeking information on the Internet is any worse. (Of course, there is already considerable literature on the topic.) Nor do I know of evidence that seeking health information on the Internet increases worry, another common concern mentioned to me.

I think the relationship between physical symptoms and worry actually go in another direction, at least as I see it. A subset of those who have common physical complaints sometimes have a lot of them, and with some frequency these are due to undiagnosed anxiety disorders or other psychiatric ailments, which often go untreated.

In short: physical complaints are never to be dismissed, no matter what their cause, and having recourse to publicly available information is not to be looked down on either.

Zackary Berger is a faculty member of the Johns Hopkins University School of Medicine, where he is an internist and researcher in general internal medicine.  He blogs at his self-titled site, Zackary Sholem Berger, and is the author of Talking to Your Doctor: A Patient’s Guide to Communication in the Exam Room and Beyond.

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  • DoubtfulGuest

    No, black and white thinking is not helpful. I don’t think the author was suggesting that patients should always be “humored”. He’s saying it’s not always a problem for us to bring information. It would be more effective if that “M” word wasn’t in the title, as it’s too emotionally charged.

    Time is a major issue here, yes? Sometimes patients put in a LOT of time outside your office, doing their own research (peer-reviewed literature) to help you think. Sometimes we are right. Often it’s not a lack of trust in the doctor’s abilities. We’re trying to compensate for the fact that you’re going to make life-altering decisions about us AND make sweeping assumptions about our characters in the space of a few minutes. No, we can’t be 100% objective about our symptoms, but we live with them 24/7. Let us be on a team with you to figure things out. If you don’t have time to discuss the internet printouts, please just say so instead of getting mad. Give the patient a chance to 1) schedule another appointment and 2) condense the information into a format that’s more useful to you.

    • Rob Burnside

      Nobody’s said it better, DG! I’d just add the observation that some patients want to be collaborative, with all the give and take that implies. Others simply want to be told what to do. It sometimes takes a little wisdom, patience, and time to tell the difference. In a typical office visit, time IS the problem. More time = greater understanding = better results. Happy Thanksgiving to you and Dad.

      • DoubtfulGuest

        Quite right, RB. D/P teams can do well either way, and we all need SOME guidance from the docs. The important thing is to have good communication about what we expect/are comfortable with. Thank you for adding that.

        Happy Thanksgiving to you, too! I’ll pass along your good wishes. :)

        • Rob Burnside

          (~) -before my mustache turned white!

  • DoubtfulGuest

    I’d lose the “M” word here as well as “ban”, although I think depending on the circumstances it may be “M” to label a patient that way.

    “Hypochondriac” is possibly the least noxious of several terms in the range of “emotional basis for symptoms” vs. “symptoms are 100% fabricated”. In my experience — maybe it’s those darn time constraints again — doctors tend to muddle them together in labeling patients, even though there are distinct clinical definitions and specific criteria. They get bandied about as alternate ways of saying “I don’t know what’s wrong”, “I’m more worried about the sicker patient in the next room”, “Your anxious, pressured speech sounds like fingernails on a chalkboard to my tired ears”.

    I appreciate the author’s post because it highlights the need to be careful, and remember we need evidence, before we conclude that patients’ symptoms are not legit. The morally/intellectually honest response would be “It may take a long time to get you a diagnosis and we can’t run every test”. Deal with the situation as it really is instead of shifting all blame to the patient.

    • Suzi Q 38

      “I’d lose the “M” word here as well as “ban”, although I think depending on the circumstances it may be “M” to label a patient that way……”

      I would agree.
      It may not be malpractice, but depending on the circumstances, it could be.

      For me, I only suspect my former doctor thought I was a hypochondriac. I complained about these small but persistent and escalating symptoms that started occurring after my da vinci hysterectomy.

      He just didn’t want to “hear” it and passed me off after waiting 5 months to his friend, a neurologist. Between the two of them, they wasted a year or so of my time before my symptoms escalated.

      I wrote a letter of concern and emailed it to my surgeon. I wanted to know what else it could be before I left for my 30th Anniversary cruise. I didn’t hear from him, so I reminded his nurse. Nurse said he had already received my letter, which meant that his inaction told me that he didn’t want to deal with me. I decided to go on my trip anyway, and deal with him when my husband and I got back.

      I had to check in with my gastroenterologist, as I started having bowel and urinary problems. He thought my condition was spinal stenosis.
      My neurologist said that I had to get an MRI of my entire as soon as I returned from my trip. I had been begging for this test for almost a year.
      When on my trip, I worsened, and came home, barely able to walk.

      Imagine everyone’s surprise at the results of my MRI’s.

      They finally had to come to terms with the fact that if they had listened, I could have gotten help a lot sooner.

      We try to be persistent and sometimes do some research because we have the time to help ourselves.

      We know many times the doctors care, but can not care as much as we do.

    • rbthe4th2

      AMEN!!!

  • NPPCP

    Why is it readily acceptable to be able to sue a physician/NP if they don’t order every test known to man, perform procedures that patients want, and prescribe drugs that patients sometimes demand out of fear they will sue them because of some guideline? You give up your ability to sue for nothing and maybe physicians/NPs will stop doing the above “for nothing”.

    • Suzi Q 38

      Suing is not as easy as it appears.
      You must prove “damages” and clear negligence.
      Also, many states have instituted tort law, which protects physicians so that they can be human and make errors once in awhile.

    • DoubtfulGuest

      I’d happily give up my right to sue. I need a solid relationship with doctors who will be on a team with me and think with me about what could be wrong. I have that now, and I hope they know they have nothing to worry about from me.

      I’m 100% sure that one of my former doctor’s fears of litigation were the main driver in decisions that actually led him to 1) misdiagnose me, 2) cover up the mistakes, 3) refuse to talk to me, and 4) send me a termination letter when I kept asking for a conversation. Actually, the letter came from his office, not him, per se. I have to wonder about his attorney’s or insurance company’s role in that. I do not have an attorney myself and I’m not going to get one. I imagine some guy in a Darth Vader suit, cheerfully racking up the billable hours, because I don’t want to believe the doctor would willingly let this happen to me. Some of us hate the status quo just as much as you do.

      • Suzi Q 38

        Your story sounds familiar, except no one sent me a termination letter.

        • DoubtfulGuest

          Oh, that was just a few weeks ago. They said they were “going to” two years ago but it never came then. So I continued to politely request a discussion. It can’t have been sent certified that first time because they’d know I didn’t get it. Nice! Maybe they sent it to the wrong address? That’s always fun when people see your personal information.

          They did finally send it certified and I signed for it. It was, however, missing several important elements of a termination letter. For example, “Confidential” was not written on the envelope, and there was nothing about advance notice or provision of any urgent care for some specified period of time. It *almost* looks as though Darth Vader himself is baiting me. I’m not going to go that route. Actually I don’t know what to do, but it stinks!

          I’ve been reading about your situation and I’m sorry you’ve been/are going through that.

          • Suzi Q 38

            Thanks for your concern.
            I feel sorry for you too.
            Have you considered going somewhere else?

            Sometimes it is better to have a different set of “eyes” looking at your symptoms and problem in order to find out what the problem is.

            Do not wait too long to do so, or precious time could be lost.

            Make sure you are getting the proper care first.

          • DoubtfulGuest

            Oh, thank you. I’m all set now. I have three fantastic specialists at a teaching hospital and a great primary care doc. All my symptoms are being treated to the best of anyone’s ability. I just feel that I need closure about the previous situation. Lawsuits can drag on forever, but all I’ve ever wanted was explanation and apology from the doctor. I’m having quite a hard time emotionally with it, especially because there was deception involved and the doctor got so mad at me. If this was just a nice doctor who made a regular mistake I could probably move on.

            Are you getting the care you need? I hope so.

          • Suzi Q 38

            Yes, I am.
            I had to consult with good friends of my son’s who are residents. One has an older brother who is a neurosurgeon.

            I was hoping for the same thing, but don’t hold your breath on getting an apology.

            I got one of sorts, in the form of a phone call from my gyn/surgeon.

            It is because of that phone call that gave me the understanding to forgive them on my own. His voice conveyed his sadness. Maybe it was at getting “caught,” LOL.

            I complained and realized that the CFO and others at the hospital will only discipline them so much, as they also fear litigation from the doctors in question.

            I did make their like a bit miserable for a short time, but I know it is not as much as I have suffered.

            I finally had to understand that some doctors are arrogant and righteous. My two were sure that I was a hypochondriac and misjudged me from the start.

            I trust that they have gotten the message.
            I still can tell my story on Yelp and other websites or submit my story for publication to benefit others in similar situations.

            My daughter, who is a nurse, just wants me to forgive and move on, as she realizes that she is vulnerable to a human error everyday. She also knows that it is a “small medical world,” and our name is not a common one.

          • DoubtfulGuest

            It’s not an unwillingness to forgive though (referring to your daughter’s viewpoint). People need to be sorry and show it. Then it’s quite easy to forgive. I don’t even need things to be phrased in a way that could open up liability. I think my state allows some “benevolent expression” or something along those lines. Perhaps they misread the law so I am getting a “malevolent expression” instead.

            I hope you get a better outcome in a way that will not affect your daughter negatively. The whole thing is very sad and I hope you get excellent care from here on out.

          • Suzi Q 38

            Thank you.
            I agree.
            Here our health is forever changed for the worse, and he can’t muster a humble and heartfelt apology.
            I get an apology and a free pizza when my order is incorrectly filled at the restaurant.

            My walking ability is greatly diminished, and the doctors have difficulty with an “I’m sorry, I thought you were a hypochondriac.”

            I still consider myself lucky to have found other, more skilled doctors who could help me.
            Mostly, I am grateful that they believed me from the start.

            I guess an MRI of the stenosis in my C spine helped my believability factor the second time around, LOL.

          • DoubtfulGuest

            I’ve got it. Let’s order pizza and…not share it with the docs. That’ll learn ‘em.

          • Suzi Q 38

            You’ve got a deal.
            Maybe that will get their attention.

          • Suzi Q 38

            “…..I think my state allows some “benevolent expression” or something along those lines. Perhaps they misread the law so I am getting a “malevolent expression” instead….”

            I think that every state should have this provision in the law. If a doctor makes an error, just try to fix it, instead of letting the patient get worse.

            Unfortunately, California does not have this law, to my knowledge.

            The Hippocratic Oath should mean something, kind of like marriage vows.

          • rbthe4th2

            I would want to see that they’re sorry so they don’t make the same mistake again. Get some education or do things differently. That’s what matters to me.

          • rbthe4th2

            and they will stick to the story, no matter how much facts show they’re wrong.

          • Suzi Q 38

            You are so right.
            If so, I wonder how they can sleep at night.
            Good people would do the right thing.
            The idea is to get rid of the bad doctors in your life.

            Thank goodness for me, they were in the minority.
            Eventually, I will get on Yelp or other publications and tell my story as a warning to other patients.

      • querywoman

        Picketing the doc’s office and home has always seemed to me the only solution, but I have never tried it.

        • Suzi Q 38

          Great idea, but most of us are too sick to sit out in the cold and heat all day.
          Also, if you did that, who else would be your doctor?
          They would be concerned that you would do this to them, as well.
          The internet may be helpful, here.
          I have seen some really bad reviews on the internet, and the general public does read this stuff.
          If I had lost my ability to walk, I would have definitely thought about what your are proposing.
          Thanks for your good idea.

          • querywoman

            Since it’s almost impossible to get the Texas Medical Board to discipline, next time I write them, I’ll probably cc the doctor and then he or she will see my exact words fast! And probably get defensive and frightened, anxious over discipline that will probably never come.
            We can use the internet to publish our stories. It’s very hard to sue for slander. When disgruntled patients make public internet posts using a doctor’s real name, the patients aren’t doing it for profit, which makes lawsuits extremely unlikely.
            It would count as a victory for the patient if a doctor actually found a lawyer to sue a patient for libel on an internet post. The chances of winning are dismal, and the patient has proved he or she really got to the doc.

          • DoubtfulGuest

            The state medical board investigation process is abusive to doctors. Unfortunately, most people are not aware…it sounds like it would be a legit outfit for evaluating legit complaints, but it’s usually not. It’s my understanding that there are no tiers/levels of investigation with board complaints. Doctors’ lives have been destroyed, even when sometimes completely innocent. I assume you’re talking misdiagnosis/poor quality care, not something egregious like sexual assault? The local medical society is more geared toward evaluating complaints about care, but my experience is that they will not help either, despite any warm fuzzy language on their website. I’m paraphrasing here but ours says something like in most cases they will find a solution that is satisfactory to both doctor and patient. Nah…they sold me some beachfront property in Arizona.

            Anyway, complaints to the licensing board are usually not the way to go, but I share your frustration that there is really no good process for us to use. The system pits us against our doctors. I’m not even going after mine on the internet, at least not by name, because I think he is having a hard enough time staying in business.

          • DoubtfulGuest

            Also, I wasn’t even looking for disciplinary action. My doctor is a grown up who’s quite capable of apologizing on his own. Most patient complaints and medical errors could be resolved in a way that is not the least bit adversarial. The way it is now, both patients’ and doctors’ lives may be destroyed so others can profit from our suffering.

          • querywoman

            What I’ve said before is we need a noncourt system that really allows access to complaints against doctors. The courts are a slow way to redress any complaint, and when we are sick, we need fast results.
            The best way is supposed to be to not pay a doctor on the way out.

          • DoubtfulGuest

            Non-court system, totally agree. I expect my problem with the medical society was actually THEIR attorney holding the strings. I know his name, but my letter bounced, conveniently, when I tried to write to him at his office afterwards. No, we can’t have any *communication* to actually *solve* any problems.

            Non-payment, though? That would ding the nurses and other staff, plus they need to keep the office lights on. Many doctors are already taking a severe hit in the wallet from declining Medicare/Medicaid reimbursements and other factors I don’t fully comprehend. I’ve only recently learned any of this. It may feel better to momentarily say “There now, you’ll have to wait to schedule that tune up on your Ferrari”. I fully admit to such thoughts (quietly to myself) in the past, but you know what they say: Forest > trees.

          • querywoman

            It dings the patients to have to pay another doctor.
            Medical payment systems have changed in my life.
            My most severe complaints were in the late 80s when a $200 deductible and 80% reimbursement after payment were the standard.
            Doctors around here wouldn’t bill insurance companies. I had to make large payments on credit cards and wait for reimbursement. And, when a doctor messed me around and neglected me, I’d have to scrape up around $80 to $100 for another one.
            At the time, emergency rooms demanded payment in advance, too, and I didn’t know that a lot of people just wouldn’t pay them.

            Then, in 1989, my insurance went to a PPO system. At the time, I only paid $5 for a visit. So it wasn’t hard to see another doctor. But, at $5 per visit out of pocket, I could easily see that docs felt free to run ever test in site and sock it to the insurance companies.
            Emergency rooms have also changed over the years, and now they have to stabilize a patient before raking them over the coals for money.
            Whatever the current payment systems are, most medical doctors and dentists are still living high, with costly cars and homes.
            Universal medical care would help, but the new ACA isn’t that!
            Perhaps in ten years it will level out!
            Each of the doctors who posts here, regardless of how they feel about medical care and malpractice, has surely had to mop up for plenty of other doctors’ mistakes!

  • Tiredoc

    My wife’s aunt complained of a wide variety of health complaints for years. She presented to her wide variety of treating physicians with the usual complaints of myalgia a, weight gain, headaches, nausea, insomnia, fatigue, rash, itching.

    She wound up losing her gallbladder for “sludge,” her (pathologically normal) appendix for abdominal pain, her uterus for abdominal pain, her parathyroids for mild hypercalcemia.

    She regaled her family for years with all of her health problems. She finally was diagnosed with hypochondriasis and regaled everyone for years that she suffered from hypochondriasis.

    As is usually the case, she died from ovarian cancer, notable for its wide variety of vague symptoms. All hypochondriacs die of something.

    Hypochondriasis is a real problem, mainly for the patients. Telling hypochondriacs to quit searching up their symptoms on the Internet is a perfectly reasonable solution from someone with an anxiety disorder.

    The diagnosis of hypochondriasis isn’t anything more than the misidentification of normal processes as pathological. It isn’t a diagnosis of faking it.

    If you do it right, diagnosing hypochondriasis is a relief for the patient, with a direct and measurable improvement in their lives.

    • Suzi Q 38

      I think that to ultimately know that your aunt died of ovarian cancer with years of the complaints listed is sad.

      She maybe had ovarian cancer all along.

      She didn’t choose ovarian cancer as the cause of her death.

      Sadly interesting.
      Maybe the misdiagnosis was the one of hypochondria.
      Another may have been a non diagnosis of ovarian cancer.

      • querywoman

        Ovarian cancer sufferers often have a history of vague abdominal complaints that were dismissed.

        • Suzi Q 38

          So true.
          I have sympathy for PCP’s that have to take care of the whole body, and realize that the patient wasn’t lying or a hypochondriac after all.

          They should feel guilty. I would.

          I thought that ovarian cancer was fairly quick (5 years) from diagnosis to death.
          I forgot that there were probably early symptoms
          when the ovarian cancer could have been very small.
          No one wants to be sick.
          We want nothing better but to feel great, and free from pain and discomfort.

          It is the pain and discomfort that is warning us.
          If it is persistent and eventually escalating, it is telling us that something is very wrong.

          Because of Tiredoc’s story, I will limit my complaints to my immediate family circle.

          No one else really wants to hear about it, even if it is something like ovarian cancer.

          • querywoman

            Yup! Ovarian cancer is SOOO fatal! It’s one of those diseases for which earlier screening techniques must significantly improve.

    • DoubtfulGuest

      Yes, I’m sorry to hear this. Some patients know that the normal little aches, pains, and twinges that everyone gets are *normal* and those are not what we report to doctors. Sure, sometimes it’s good to start with H as a working diagnosis. If those improvements don’t come in some reasonable amount of time, I’d hope you consider alternatives then?

      • Suzi Q 38

        It is far easier to dismiss a patient as a hypochondriac, than to actually do the detective work required to get to the bottom of a myriad of health complaints.

        Unless the doctor is also a psychiatrist, I would hesitate to label someone with such a condition without a thorough medical workup.

        Someday, these young doctors will grow older like the rest of us, and unfortunately experience some of our treatment.

        Maybe they will realize that getting the label hypochondriac is not only demeaning, but dangerous.

        • DoubtfulGuest

          I would add that psychiatrists can be extremely helpful for the undiagnosed:

          “Hmm. You look ill to me…Really, just a blood count over and over again?…Well, that hardly establishes you’re healthy…I see depression all the time in folks with serious organic diseases, it’s normal…You might consider a second opinion?… These symptoms have been going on for an awfully long time…I don’t mean this unkindly, but you really LOOK awful…”

          :)

          • rbthe4th2

            They certainly are when they tell the doctors, there’s nothing wrong with the mind here. LOL.

          • DoubtfulGuest

            Right, and often when there IS. They can be really good at considering different organic bases for psych symptoms. Endocrine, neurological, systemic toxic exposure…there may be more than one thing going on. In any case, to sort things out and get patients the care they need without judgment.

  • DoubtfulGuest

    Absolutely. You’re not using those terms in a perjorative way. I freely admit to some hypochondriacal fears for awhile there. Was worried about different kinds of cancer since I had fatigue, weakness, and unwanted weight loss. Turns out it’s something completely different and almost as bad (an IEM). Some of us do have insight about emotional stress and we could all deal with this aspect honestly if we got rid of the stigma.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    ICD-9 300.7 is a perfectly valid billable code. Just sayin’…. :-)

    • ninguem

      Margalit

      ICD-9 569.42

      is a far more appropriate code

      Once familiar with the code, you can use it on a daily basis. I bet you know many 569.42 in your day-to-day life.

      Go on Zazzle or similar sites, you can get ICD 569.42 T-shirts.

      Give one to your 569.42 friends, acquaintances, co-workers.

      Mrs. Ninguem gave me one.

  • Zackary Sholem Berger

    Hi all –

    I just saw the discussion now, after seeing patients, EPIC-surfing, and getting the kids to bed. Thanks for all the comments!

    The downside of the great KevinMD.com reposting opportunity is sometimes I wish I had edited the blogposts more. I agree with two comments repeated a few times below:

    1. “Malpractice” was an inflammatory term to use. I should have picked my words better. I will try not to do that again.

    2. Indeed, hypochondriasis, as I was reminded below, is a real clinical entity which can be treated (if rarely cured). Cf. the latest JGIM issue comparing CBT to relaxation therapy, both of which are effective.

    Somatization is another term, obviously, with different criteria.

    However, too often these terms are wastebaskets, ways to ignore the patient in favor of a convenient dismissive diagnosis.

    So – a lot of you are right on the money. I think some of my points still stand, however.

    Thanks for reading!

    Zack

    • rbthe4th2

      As one who has been dismissed and blown off, you’re on the mark. Plus, too many docs think they made a mistake and I’m going to get sued. When I send, in writing, to your hospital employer, that I wanted their docs to fix the mistake, apologize and move on (because I have a life and not time to deal with stupidity, in a nutshell), that should have been a big warning flag.
      Because if you do it once, you’ll do it again, to someone who is going to sue you.

      • DoubtfulGuest

        Yes, Dr. ZSB is a Good Egg.

        • Zackary Sholem Berger

          aw, shucks. can you tell that to my tenure committee?

          • rbthe4th2

            I do for all docs who are honest, who admit mistakes and try to fix them. I actually ask who their bosses are so I can say thank you and WHY.
            Randy

      • Suzi Q 38

        This is true.
        Some people have the money to sue and want to spend it on legal fees, they are that angry.
        Most though, realize that it is just too costly.
        If you spend enough, this does increase the chance of winning.
        Sad that it has to come to the threat of a lawsuit at all.

        • rbthe4th2

          The problem is that with the way medicine is working right now, that’s about the only way for change. Doctors policing doctors works about as well as politicians and lawyers policing themselves. There is basically no accountability for the number of mistakes made, and trying to get value for care isn’t making headroads. That’s not what people are paid for.

          • DoubtfulGuest

            Sure looks that way, or may be a snow job on the part of the legal system? I have read that plaintiff’s attys and med mal defense attys are often friends. We can’t rule out their drumming up business for one another. Drs. need defense attorneys because patients are likely to sue, right? There are a few looking to hit the jackpot, yes. But I think it’s a combination of fatigue/time constraints + this fear that doctors live with that is actually the root cause of most mistakes. Okay, and system errors, too.

            I’m just very suspicious, given my own experience. When I first realized what had happened to me in terms of misdiagnosis and cover up, I was hoppin’ mad. What did my doctor do? Stonewalled the heck out of me. Probably following atty’s advice. He MAY have even been ordered to do this by his insurance company. Lots of research shows this approach will push patients to sue who might not have done so before.

            My limited understanding is that a malpractice insurance company may not mind if you sue, even if you win, because they can just increase the doctor’s premiums. A defense attorney employed by the insurance company will be happy to get the billable hours. As long as they can create the appearance that we might sue, they can charge the doctor to keep a risk management file open on us.

            I don’t mean to lecture, Randy. I want doctors to see this and help us out! :/

          • rbthe4th2

            I totally agree. To be honest, medical school needs an overhaul. Now that people can read peer reviewed medical literature and other items, I find that the old way of doctor only trusting their training/education, their cohorts, isn’t really a viable way for things to work any longer. Its great for basic stuff but anything out of that and everything is at a loss.
            I don’t see it as a lecture. I just want docs to take a very hard and serious look at the problems we have and see what we can do to fix things. For the love of heaven though, with all due respect to any one, the more lawyers and suits (only a few decent ones) we can keep out of it the better. I would also like some NURSES in the fray. I’ve had a problem nurse, but otherwise, the vast majority of them are great.

          • DoubtfulGuest

            Excellent point re: nurses and NPs. Right On!

            Lawyers and suits, suits and lawyers…I was in a car accident 10 years ago. Had never met the other driver until he brought his car into intimate contact with mine. I was injured, hired a lawyer — real nice down to earth guy. He helped me get a small, reasonable settlement.

            Compare this scenario with the doctor who misdiagnosed me. (I have a neurological/metabolic disease unrelated to the accident). I willingly placed my life in his hands, and now he won’t talk to me. The lawyers horn in on what used to be a sacred relationship. I have no problem with them as people, but they need to butt out where they don’t belong.

          • rbthe4th2

            They have their uses, but to be honest, it really needs to be few and far between. I think if we can get some of the mentality of sue sue sue or everything needing to go on Jerry Springer (I saw parts of the show and my jaw dropped) dumped out, we could all get along. The other would be for docs not to cover for others mess ups, admit problems, fix them with patients. I think it would be a good thing to also if docs, while doing the first visit paperwork, get the PATIENT to say what kind of doc they would want: they make the decisions, they give you treatment options, you decide, they decide. How important is having treatment options to you and how do you want them presented? Do you like to research internet information and give the top 5 websites you go to? That would be a BIG help. What do you all think docs? That might allow personalities to gel between some patient expectations and doctors practice theories.

  • ninguem

    I looked up my symptoms on the Internet.

    I’ve got something called “HTTP 404″

    Is that serious?

    • http://onhealthtech.blogspot.com Margalit Gur-Arie

      No, no, no… you go to Healthcare.gov to buy health insurance, not to get health care…. :-)

    • DoubtfulGuest

      Yes!!!! It’s deadly!

    • querywoman

      Do you dream in pixels? I do!

  • querywoman

    Another term used for hypochondria is, “depression.” I have been taking thyroid medicine since I was 17. In my early 20s, a drop in medication led to serious menstrual disorders.

    Of course, the cause was “depression,” and I was blown off. In spite of hiring various endocrinologists, I continued to have menstrual difficulties which were blown off and trivialized while yoyo docs diddled around with the blood pressure cuff, and recommended cholesterol and cancer screenings.
    I won’t go into at all, but my blood sugar eventually went up to diabetic level. I improved with various blood sugar therapies. I had an excellent response to metformin, and I probably have polycystic ovarian disease.
    I was apparently in a subdiabetic state for many years, and they are learning more about that state all the time.
    After becoming diabetic, I find that doctors take all of my symptoms more seriously. I have some excellent docs now. But, I should have been taken more seriously in those early years.
    And now the term “autoimmune” has become come. I have serious atopic eczema, which is probably an autoimmune disease.

    • querywoman

      When I look back, as I often do, it still stuns me that my subdiabetic state wasn’t recognized. Diabetes and thyroid disorders are the most common endocrine disorders, and often linked.
      Nondoctors, my friends, often thought I was diabetic before I went into diabetes. Instinct!

      The first endocrinologist whom I went to in about 1987 thought I was diabetic. I think my fasting sugars may have been close to 140, and he didn’t consider me diabetic.

      I knew he was a lot more interested in his diabetic patients than a hypothyroid woman with a menstruation disorder. I had never heard of PCOS. Diabetes runs in both my families, and thyroid problems are rampant in my mother’s family. My father’s diabetic sister has male pattern baldness.

      Back then diabetes was dx’d at 140. It’s been dx’d at 126 for years now.
      He has awful. I have never been able to find out much about him, other than that he seemed to be a solo practitioner with no research accomplishments and no verifiable linkage with other diabetes facilities.
      Another endocrinologist with wider connections might have been more interested in prediabetic patterns. And my second endocrinologist was hardly any better, though I knew he had some “connections.”
      If I had been dx’d with PCOS, I feel confident I would have only been told to lose weight. I don’t know if metformin would have been prescribed. When I went into diabetes, metformin helped my menstrual problems immensely, even though I was getting closer to menopause.
      I used to be infamous for getting most of my calories at one meal. A diabetic pattern of eating, with smaller meals and the calories spread out over the day, would have probably helped me. Smaller frequent meals, staying on schedule, seems to be the one universal standard for diabetics, whether they are still able to control it on diet and exercise or have advanced into treatment.
      Today, I did a followup with my sixth endo, who seems to have a wonderful grasp on all my endocrine misfires. I know that stuff is vague. But, with more meds in his arsenal, I think he is able to make better guesses on what a person has and interpret from their responses to different meds.

  • rbthe4th2

    Hey Dr. Tired,
    (Warning symptoms listed)
    I presented with abdominal pain, swelling, nausea/vomitting, early satiety, indigestion, dark yellow urine that was strong smelling, weakness, etc. and the GI doc did nothing but call me anxious, anorexic (if I was a 16 year old girl who was skin and bones, but I’m not AND his scales said I gained a few pounds) and dismissed me.
    A few months ago I had low albumin, total protein, etc. and my liver values are dropping, creatinine is dropping too.
    You don’t call that malpractice?
    Randy

    • Suzi Q 38

      It is sad, but even when you have a physician in the family, they don’t think that your complaints are medically valid.
      My friend is married to a physician. She said he rarely acknowledges her health complaints.

      I told her that she needed a new physician, and to quit asking her husband.

      I have learned.
      Just go to a better doctor who will listen.

      • rbthe4th2

        True but the guy didn’t even do a physical exam.
        Some of that is the way they “teach” the “hidden curriculum” in medical school. I understand why but it can have its drawbacks.
        You’re right. Shoot I’d never ask my spouse that. You never know what they’ll say.

      • buzzkillerjsmith

        “He rarely acknowledges her health complaints.”

        You really tickled my funny bone with that one, Suzi. A microcosm of the whole health care edifice, eh?

        I once was told by a coworker of mine that a female patient was very happy with my care because it was the first time a male doctor had ever listened to her. I guess I kinda took it as a compliment.

        Maybe it will get better with more women docs. Maybe not.

        • Suzi Q 38

          “…..You really tickled my funny bone with that one, Suzi. A microcosm of the whole health care edifice, eh?….”

          Yes. I would have to agree.
          I now ask doctors if they listen to their patients. If they are not sure of what I need or feel uncomfortable at my asking, I than I would just thank them for their time and move on.

          My new doctors just say they have no problem with that and hand me a business card with their work email address.

          I was the most impressed with one doctor, who is about 80. He is an expert in his field and had tried to retire twice, but was called back to continue his research and work.

          He told me to email him at any time of the day or night, and he would NOT get back to be right away, but within a day or two.

          If an 80 year old could change and try to increase communication with his patients, I think more physicians should give it a try too.

          My new gyn/oncologist/surgeon is female, LOL. My gyn called her ahead of time and ask her if she listened to her patients. He told her that his patient wanted to know. It was a personal and specific request.

          Kind of embarrassing, but it did the job. She listened well. She devoted 10 full minutes and let me talk about my history.

          She has that luxury. My PCP does not, so I just make sure to get an appointment when he is the least likely to be busy.

          To figure that out, I had to check with his receptionist and nurse.

          • buzzkillerjsmith

            ADD, no. Mind elsewhere, almost always.

          • Suzi Q 38

            Focus, Doc, focus.
            LOL

      • querywoman

        This is easy. A plumber doesn’t fix his own plumbing. A doctor is no different. Doctors should not treat their own.

        • Suzi Q 38

          Very true.
          Happy Thanksgiving!

  • Suzi Q 38

    Well said.
    Thank you.

  • May Wright

    And one of the problems with universal electronic medical records is that any “label” will follow you around forever — precede you, in many cases — and whether or not it was accurate, there’s a good chance it will affect any treating physician’s impression of your presentation.

    If, before they even see you, the doctor reads that you have been labeled “anxious”, “depressed”, “troubled”, “non-compliant”, “argumentative”, “difficult”, a “hypochondriac”, etc., that’s a worry.

  • fatherhash

    i guess some believe that doctors are supposed to forget the story of the boy who cried wolf…..not that the patients are intentionally crying wolf.

    • DoubtfulGuest

      fatherhash, I notice you have quite a few comments re: medicolegal stuff. Any insights for us? We’ve made it pretty clear that we’d like to stay on the same side as our doctors.

      • fatherhash

        haha, i love pizza. i was just trying to say that doctors are not infallible robots and do need to use common sense. many times, with a “hypochondriac” patient the doctor at some point needs to see what is looking like a duck, quacking like a duck, and walking like a duck for what it is. in my experience, patients hate being told that their symptoms might be related to anxiety/depression….so it’s always a gentle conversation.

        yes, doctors makes mistakes all the time. but all symptoms and signs must be taken collectively to come up with the best diagnosis at that time. multiple vague symptoms become more challenging in that a definitive answer(which is what patients and their doctor wants) can not always be found….at least not quickly. patients many times perceive this lack of a quick answer at being “blown off.” sometimes, it’s just part of the trial and error that happens in medicine every day….a treatment/test is suggested/tried, then you wait to see what happens, then reconsider as needed.

        • DoubtfulGuest

          Excellent. I know some feel it’s heresy to warm it up the next day. ;)

          Thanks for your thoughts. I agree and there are quite a few people willing to jettison the idea that doctors can or should be perfect. We who ordered pizza have doctors who made mistakes (okay, we were not po’ed yet), then were verbally cruel/nasty (not cool!), deceived us or put up roadblocks to
          getting the care we needed (boo! hiss!).

          Let’s say there were misunderstandings? We have not been allowed to understand the facts. Often, we don’t even know who all on the doctor’s end is preventing communication: personal attorneys, insurance attorneys, insurance adjustors, office staff, the doctors themselves?

          As far as I can see, no one here is seeking legal recourse, but we’re no longer treated like the vulnerable patients we are. To make matters worse, whoever’s preparing to defend these nonexistent lawsuits has access to our personal private information that was only meant for our doctors’ eyes.

          Back to hypochondriasis, the iterative process you describe sounds just fine. Sometimes, docs forget to say “If the symptoms continue, please come back and we’ll consider some other possibilities”. That may be the #1 factor in patients feeling blown off. HOW you say it is important, too.

          When I was still undiagnosed, I used to say it
          feels like a freakin’ volleyball game, where your doctor is really really good, and you don’t even know you’re playing. You put all this thought into
          explaining your symptoms, i.e. serve the ball, the doctor yells “GOT IT!!!!” and before you know it the ball is back over the net. We need you to hold the
          ball and think about it. :)

          OTOH, it’s good for patients to know that the comfort/education part of your profession includes trying to help patients think in a way that will allow symptoms to go away on their own. It’s reconsidering in a reasonable amount of time that’s key. “Reasonable” varies, of course, but surely it’s something on the order of months, not decades. Happy TG, fatherhash, and thanks again.

  • Suzi Q 38

    Yes! Exactly!

    A little sympathy would go a long way with anyone who is hurt, especially physically.

    My friend just needs to get a complete check up by another doctor.
    I am going to have to break the “news” to her that he thinks she is fine, and he has not even examined her, LOL.

    I have some sympathy for him as he is a good husband, father, and doctor. His patients are far more ill than she is, so he dismisses her complaints.

    I told her she was “barking up the wrong tree.”

  • buzzkillerjsmith

    Docs make pretty lousy nurses. Here’s one for you: Where do you find sympathy? In the dictionary between soldier and syphilis.

  • buzzkillerjsmith

    That’s how I heard it too, most of the time. But I’m trying to keep at least a shred of dignity at this blog.

  • Robert Luedecke

    I am a physician who has one of those head and neck pain syndromes with very strange-sounding symptoms. Before I had a diagnosis, I was reluctant to tell my doctor all my symptoms, because they sounded so bizarre. I am extremely fortunate my “pain doctor” recognized that just because he did not know all about my specific problem did not mean I had a psychiatric condition. I had one neurologist tell me it was not medically possible to have pain like I had. It is very important all physicians recognize what is strange today may be next year’s well-described syndrome.

    • Suzi Q 38

      I understand what you are talking about.
      I was afraid to tell my doctor with each visit that the sensations were not going away. I could see his disappointment, and almost impatience, increasing with each description of my symptoms.

    • querywoman

      Try having a skin disease. My atopic eczema builds up in white layers, and my own skin is very pale anyway.
      So that made me delusional!
      My current dermatologist is an activist for psoriasis. I get similar treatments. If each get two more lives, we can probably accomplish tons for autoimmune skin diseases.

  • Suzi Q 38

    You are so right.
    You have given me very good advice.

    They are probably taught that in medical school.

    Maybe it is something like this:

    “Patients who present with general aches and pains, that have no underly cause, are possibly depressed or anxious…..”

  • Suzi Q 38

    I am so sorry.
    I hated having the doctors dismiss my complaints.
    I think that if you are of the menopausal age or older, you get a label of sorts. I had to push hard to get my diagnosis a year and a half later, and it was tough getting doctors to “hear me” or listen.

    I had lost a BIL to pancreatic cancer two years prior, and his main complaint was back and stomach pain. They gave him Advil, then Vicodin. Eventually, after several years, he couldn’t move and this landed him in the ER.

    They found his cancer, alright. Stage 4 with mets. He died two months later.

    • DoubtfulGuest

      We need an “I’m so sorry for your loss and the circumstances under which it happened” button.

      “Like” isn’t cutting it here.

      Ditto, chaplaindl.

  • querywoman

    Gastric cancer! Ovarian cancer! Mammograms don’t catch them!

    • Suzi Q 38

      What does?

      • querywoman

        Nothing that I know of Suzi Q! But, when I complain about mammograms, pap smears, blood pressure and cholesterol screening, prostate screening being done on as symptomless people, I’m including stuff like gastric and ovarian cancers: stuff that has vague early symptoms that are dismissed!
        Not just my own complaints!
        I don’t know why I have lived my adulthood in a time when the medical climate ridicules symptoms while upselling preventive screenings.
        I think it’s the People’s Medical Society who calls this, “making patients out of healthy people.”

  • Andy

    “…doctors who use that word are committing malpractice.”

    Uh… Then perhaps they should take it out of the DSM, ya think??

    Yes, physical complaints must all be taken seriously, but don’t throw the baby out with the bath water. There are, in fact, hypochondriacs out there, and doctors need to call a spade a spade; if the patient is never challenged or confronted with the actual problem (e.g., hypochondriasis), they may never change. The doctor may actually be enabling the problem rather than helping the patient deal with it. I think I understand your premise, but your above statement is patently false.

    • DoubtfulGuest

      True enough, Andy, but please don’t forget to keep listening and looking for patterns in the patient’s symptoms over time.

      No, we can’t chase down every symptom with expensive testing. However, several of us here had multiple doctors give us *the talk*. It’s kind of endearing how each is sure s/he’s the first to stem the tide of unnecessary testing and tell us what’s really going on.

      Sometimes, it’s turns out to be a serious disease that’s uncommon or has a weird presentation. I’m writing to all of my previous doctors so they know how my case turned out. I don’t want them to count me in when they tell future patients “I see this all the time and it usually turns out to be nothing”.

  • querywoman

    My father, who was a super competent electrician, did a few things substandard, but generally not to the point of any danger.
    My parents divorced in my early 20s.
    An air conditioning man told my mother that my electrician father didn’t put the best part on the central air conditioner. Daddy told me he knew it wasn’t the best part. Maybe it was the cheapest.
    It takes a lot of guts for a doc to do his own vasectomy!
    I usually prefer to do EVERYTHING I can for myself, especially paperwork. In the past, when I need letters from docs for work or disability purposes, I usually just wrote them myself and got them to sign it.
    I don’t do my own housecleaning, though! That’s where I am a dunce and a slob!
    So who do I respect? Cleaning people!
    I’m not sure that my own attempts are ever good enough to really call “cleaning.”

  • davefromcamp

    Maybe we shouldn’t throw the word malpractice around so much

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