The Good Doctor — And The Difference It Makes

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I’ve been thinking a lot about doctor-patient interactions and diabetes education recently (related to the project I described in a previous post) — and I recently had an experience that made me realize, yet again, the difference a good doctor can make.

On the surface, this didn’t have to do with diabetes. A few weeks ago I pushed myself a little too hard at the gym and came home to realize that I had done something bad to a spot at the back of my right shoulder. It felt like something had been tweaked, and if I moved my arm the wrong way, I was hit by sudden, acute pain. Considering the fact that I already have osteoarthritis in both knees, this was especially bad news: at 32 years old, I was left with only one fully functioning limb. This was also a problem because the gym I’ve joined is based entirely around cross-training classes, and in addition to cardio work, each class includes 30 minutes of weights and 15 minutes of yoga/stretch — all activities that are potentially quite shoulder-intensive. I was very frustrated, not just because I have a tendency to imagine myself as disgusting and fat if I skip a workout for more than a day (ah, how I love being female) but because  exercise is crucial for managing my blood sugars.

So. I took a week off, and when the problem still had not gone away, I made an appointment with a sports orthopedist. I didn’t think he’d be able to fix the problem, but I wanted to get a better sense of what was going on.

Before my appointment, his office sent me a detailed health intake questionnaire — not just your normal “What’s the problem and what meds are you on” stuff, but questions like, “On a scale of 1 to 5, how easy would it be for you to lift a soup can to shoulder height?” and “Could you place a gallon of milk on a top shelf?” I’m serious. There were like, ten grocery-placement questions — each of which required me to sit back at my computer and try to simulate the feeling of a can of Campbell’s in my right and left hands. The whole thing took about a half hour. I worried about the accuracy of my soup responses, but overall, I was impressed that they’d sent me the questionnaire ahead of time. How efficient and technologically advanced, I remember reflecting. And what creative use of props!

Fast forward to the waiting room: after sitting there for an hour and forty five minutes (god, how I hate that) I was eventually called to the front and given a different questionnaire.  “I already filled one out online” I said.

The receptionist looked at me, confused.

“There were all these questions about milk?”

“I have no idea what you’re talking about.”

Lord knows who sent me the intake questionnaire, but apparently they had not alerted the actual medical staff, because I had to fill out my forms again (thankfully free of the grocery questions) — which left me more irritated than I’d already been about how long I’d been sitting there. Then, after a resident arrived and asked me to explain my problem (note to doctors: if you’re running two hours late, please skip the resident practice session and just come in yourself), the doctor eventually came in.

I explained my problem. He twisted my arm in a bunch of different directions, asking how it felt. I explained how I’d hurt it.

Then he quickly said something about a potential labrum tear or a ligament problem and ordered a round of anti-inflammatories — a prescription for Motrin.

Now, the message was obvious: he didn’t know what the problem was, so he figured he’d give me some NSAIDs and see if that helped. But I’m not the kind of patient who’s happy with that level of diagnosis. Fine, I understand he didn’t know exactly what the problem was, but I wanted to understand his hypotheses. What is a labrum? What ligament did he think I could have torn? What activities could I do? What were the potential solutions?

He did not want to answer these questions. Instead, he got vaguely defensive, and suggested a different possibility: that this could be the beginning of frozen shoulder, brought on by diabetes.

“One in five people with diabetes develop frozen shoulder,” he announced, “regardless of their control.”

Right. So when you don’t know the answer, you drop the diabetes scare tactics. I mean, fair enough — frozen shoulder apparently *is* more likely to occur if you have DM (though I don’t buy the control part). But dude, I’d explicitly told you I’d injured my shoulder by being overaggressive during a tricep stretch! This had nothing to do with diabetes!

Anyway, I left the office with my prescription for Motrin feeling really pissed off: I hadn’t had any questions answered, I’d left for a prescription  for something I could have bought for myself, and I’d wasted two and a half hours of my day. Grrr.

It’s now two weeks later, and the problem still has not gone away. So I went to a different doctor.  I didn’t know if it’d make a difference — and indeed, this guy didn’t know for sure what the problem was either — but here’s the thing: whereas I left the first doctor’s office irritated and frustrated, I left the second doctor’s office feeling empowered and happy — despite the fact that he concluded that there was a chance I might need surgery. The difference was that this second doctor didn’t seem intimidated by questions. He seemed to appreciate them. He explained that if you tear your labrum you’ve essentially pulled a bit of cartilage off of your joint, and that it was unlikely to heal on its own. A torn ligament, on the other hand, *would* heal. The way to determine which it was is something called an arthrogram MRI, a special MRI where they inject dye into your joint so that they can see if there’s a space between your cartilage and your bone. If it’s a torn labrum, I might need surgery — but that decision was up to me (as well as the decision about whether or not to get the arthrogram MRI to begin with). Throughout all of this, he did little demonstrations — pulling on the fabric of his suit to show where various movements put pressure on his shoulder, and even using a slightly loose board on the wall to demonstrate a torn labrum.

I guess I’d recognized this already in other doctors, but I continue to be amazed at what a difference it makes to have someone who is not intimidated by questions, even if they don’t know the specific answer. It also feels very different when a doctor puts some degree of control and decision-making into *your* hands instead of the other way around. I think it’s the same with endocrinologists. Having been to four or five by this point, it is amazing to me how the exact same type of appointment (i.e. a routine checkup) can leave me feeling radically different — from holding back tears (or downright crying in the bathroom) to actually feeling happy as I walk out the door.

I’m now even more committed to the idea that if a doctor’s appointment makes you feel bad, it’s not your fault: it’s probably the doctor’s. So why stick with them? If you’re at the doctor’s office to begin with, you’ve probably got some sort of affliction that you’re upset about. The last thing you need is for your doctor to make you feel worse. So stand up for yourself! Ask questions! See how they answer them. If the result is unsatisfactory, remember: you’re the one who has the power to make a switch.

 

 

 

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Bridget McNultyJeff Horacek MD Recent comment authors
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Bridget McNulty
Bridget McNulty

I couldn’t agree more – my diabetic doctor at the moment is an absolute winner, and I actually look forward to going to my check-ups! No matter what I bring to him, he explains it carefully, listens to my emotional outbursts, and leaves me feeling happier and more in control of my condition. I think a good doctor is like a husband – if you find a good one, hold on tight!

Jeff Horacek MD

Hi Catherine, first of all, sorry about the shoulder.  Hope it is getting better.  The problem seems to me we are training doctors in too authoritarian style.  We need to do a better job of recruiting people to medical schools skilled at interpersonal relationships and then develop that over their careers.  I’m afraid the system (at least when I went through) was designed for each doc to be expected to have all the answers and to be the sole “captain of the ship”.  I agree with you, we need to learn better ways of developing partnerships to help empower the… Read more »

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