How to Get Your Doctor to Listen: Tips from a Patient Who’s Been There

How to Get Your Doctor to Listen: Tips from a Patient Who’s Been There

As a patient who was horribly misdiagnosed (they told me I had fibromyalgia but it was really a brain tumor) for more than two years, I learned a thing or two about how to get your doctor to listen.

Going through life with a misdiagnosis—or no diagnosis at all—is as hard to bear as whatever’s ailing you. Not everyone is born a self-advocate. It’s something we must learn and practice.

So here’s what I’ve learned. I sincerely hope it can help you too.

Why Won’t Your Doctor Listen?

It may be that your doctor, though well-intentioned, isn’t picking up on what you’re telling her. Or maybe you’re not communicating as clearly as is needed. Or, you know, maybe your doctor is just an asshole. (I’m telling you some of them are.) For me, it was a little bit of everything.

First, let me assure you that if you are currently facing this struggle, there’s a good chance it’s not your fault. There’s also a good chance you’re a woman. The problem of sexism in health care is long-running and systemic.

According to Prevention, for example, women are 50% more likely than men to get a wrong diagnosis after experiencing a heart attack, and hysteria wasn’t removed from the DSM until 1980.

Nineteen-freaking-eighty!

But as the world can attest, cutting ridiculous junk from a manual doesn’t automagically remove stigma and prejudice from a profession or a populace. From psychology to surgery, health care is still plagued by crap assumptions that undermine the care of women.

And it’s not just the old white guys who are guilty of perpetuating harm—women doctors do it to women patients, families and friends do it to people they love.

We. Do. It. To. Ourselves.

My Misdiagnosis Story in a Nutshell

For me personally, the trouble started because I was a woman in my thirties presenting with chronic pain. It was generalized, meaning I hurt everywhere not just my elbow or my neck. And because the pain prevented me from being active, I was also gaining weight.

Before a single drop of blood was taken, a nurse practitioner told me I probably had fibromyalgia. I was tested for arthritis and a handful of autoimmune issues straight away, then referred to a rheumatologist the following week.

When the blood test results were wholly unremarkable, the rheumatologist presumed me to just be a pudgy, complaining woman in need of antidepressants.

Unsurprisingly, he officially diagnosed me with fibro, a condition with a unique and horrifying stigma all its own. And when his (mis)treatment plan failed to help me, he put the blame squarely on my shoulders. His demeanor toward me turned hostile, he communicated with me like I was an ignorant, troublemaking child, and he was outright belligerent when I asked him questions.

How dare a uterus-having technical writer ask if maybe Cymbalta wasn’t The Answer.

That’s when I knew without a doubt my rheumatologist was a lazy stinking misogynist, which brings me to my first bit of advice.

Tip 1: Fire All the Assholes

Yes, I know what I’m saying is very difficult to do in a lot of cases. Restrictive insurance networks, a limited number of doctors in your area, and sheer exhaustion from your illness can make finding a new doctor all but impossible. But your health is the thing, and you can’t protect it if you keep leaving it in the hands of an asshole.

Cry because it’s hard and unfair. Absolutely do that. But then remember that you don’t have to solve the problem in one day. Promise yourself to look for a better option and jump at the opportunity when you find it.

Tip 2: Expect Struggles with Good Doctors Too

Not all my doctors were so lazy and horrible, but by the time I was ready to give another doctor a try, Dr. Asshole had already done his worst.

He was given the benefit of the doubt at every subsequent doctor appointment I had for the following two and half YEARS, and at least a dozen more MDs and PAs and NPs tried their best to persuade me I really did have fibro after his misdiagnosis.

It’s maddening if you think about it too long, but medical professionals—even fired ones—are always presumed to know more about being sick than the people who are sick. You’ll need to mentally prepare yourself for this reality before every appointment.

Tip 3: Take Time Off from Seeing Doctors

Meanwhile, I continued experiencing symptoms that didn’t really fit with fibro. The unexplained haunted me, and I got sicker. I surfed WebMD and Dr. Google and tried to diagnosis myself. When I asked doctors about the things I’d learned, it didn’t go well. If I wasn’t ridiculed on the exam table, I was politely ignored.

There were days when I felt like I just couldn’t do it anymore, so I didn’t. I took time off from going to appointments and even scheduling appointments until I recovered enough strength to deal with more heartache from doctors—people I was taught to trust with my life. I told myself I’d go again when I had the energy to communicate without bursting into tears.

And, yes, I did break down a few times. It’s inevitable, dear human. Don’t beat yourself up about it like I did.

Tip 4: Ask To Rule Out Diagnoses

I had infinitely more productive appointments when I stopped asking “Could it be X?” and started asking “Can we rule out X?” I don’t see why such a subtle change should matter so much, but it did.

Doctors were less likely to see me as a difficult, self-diagnoser and more likely to see me as a diagnostic partner when I asked if we could rule something out instead of confirm it. In fact, no one bothered to order a single MRI until I asked, “Can we rule out MS?”

Folks, that first MRI is how they found my brain tumor. Or, as I see it, how *I* found my brain tumor.

Tip 5: Recognize the Bullshit You’ve Internalized

We can be our own worst enemy when we take in and internalize bad messages from external sources. Sexist and ableist ideals can ooze out of us without our realizing it. We can be gaslit by medical pros without seeing the harm because we’re taught to treat them as authority figures or saviors instead of trained diagnosticians paid to do a job.

Mull it over for a bit and see if you’ve fallen into traps that affect your ability to self-advocate.

  • Do you hear yourself as a reporter of facts or a complainer when you tell a doctor your symptoms?
  • Do you think all your problems would go away if you could just lose the weight?
  • Do you always think you’re sick because you’re depressed and not depressed because you’re sick?

That asshole rheumatologist I mentioned before? He’d only ever seen me fat and just assumed I was lazy and overeating. He had no idea that less than a year before I was running 5Ks on the treadmill or completing a Jillian Michaels’s Shred workout in my basement five times a week.

Still, I had to fight like hell not to let him gaslight me. He nearly had me convinced I was fat and lazy and my pain was imagined.

Tip 6: Take Someone with You

I’m as independent as the day is long, and I’ll tell you I hated bringing my husband to appointments with me at first. Not because I minded him being there, but because IT SHOULDN’T FUCKING BE NECESSARY. (Ahem, sorry. This will always be a sensitive subject for me.)

However, when I couldn’t put my own underwear on or get myself out of the bathtub anymore, I relented and asked him to join me at my next appointment. Being stubborn about it might’ve killed me, looking back on it. Anyway, having a man in the room changed the way all my doctors behaved. Some definitely more than others.

Turns out it would later become absolutely essential for Dan to attend my appointments. The point is that I probably should have asked sooner than I did, given how the world works.

Tip 7: Connect with Other Patients

I know there are patients out there with different perspectives who have learned things I haven’t. I encourage you to seek them out. There’s an entire community of doctors and patients on Twitter, for example, who are constantly sharing what they know. Seek them out.

And if you’ve got a story to tell, questions to ask, or tips to share, please comment on this post for the benefit of others. We’d love to hear from you!

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A Thing I Did While Growing a Brain Tumor

A Thing I Did While Growing a Brain Tumor

Facebook tells me that on this day three years ago, Dan and I attended the Dave Matthews Band concert at Summerfest in Milwaukee. I remember it well. It was raining and only like 50° F outside. We could see our breath.

In July.

Fuckin’ Milwaukee, guys.

Anyway, we had lawn tickets but no chairs or blankets, because we weren’t anticipating the rain or the cold, slippery grass.  So I stood for the entire show. For HOURS. I wiggled and danced for a bit, walked around a little. Then stood still. Then shifted my weight from one leg to another. Then started the routine all over again.

At the end of the concert, we had to walk back to the car. My legs were tired. The car was parked several blocks away, and I remember saying to Dan, “My legs feel weird. Like I can’t walk. I don’t know if I can make it all the way to the car.”

I had no clue what was happening to me at that time. I just thought it was exhaustion and that I was really and terribly out of shape. (Even though my height, weight, and activity levels were still leaning toward the decent side of healthy because I’m stubborn.)

At that point, I had already started seeing doctors about weakness and fatigue and a bizarre sort of limp that came and went, but I wouldn’t get a fibromyalgia diagnosis for about three more months.

I wouldn’t learn I had a brain tumor for a couple more years.

I did make it to the car without aid that night. But it was hard, and I remember stifling fears that something was really wrong with me. I remember plopping in the passenger seat and sort of lifting a leg into the car because it just wouldn’t.

Anyway, I wanted to take a moment this morning to say I’ve done a lot of really hard things with a tumor in my head—a tumor that I knew nothing about. Wonder what else I can do now that I know and have doctors that know how to fight it.

Fibromyalgia Misdiagnosis: Surprise, It’s a Brain Tumor

Fibromyalgia Misdiagnosis: Surprise, It’s a Brain Tumor

Whew! The past 72 hours have been utter shit for me. I’d explain why, but I’m going to just wave my Tumor! sign and leave it at that. There’s something else I want to write about now: my fibromyalgia misdiagnosis.

Did you know that May is Brain Cancer Awareness Month and Fibromyalgia Awareness Month? (Actually, May is the awareness month for a lot of things, but these two things have been just about my entire life since October 2014, so they’re getting top billing on my blog this May Day.)

I mentioned in a previous post that I believe fibromyalgia was a misdiagnosis for me as opposed to a comorbidity. As I have discussed many times with family and friends, I am mostly overjoyed to have an accurate diagnosis and a real plan to get better.

However.

There’s a special kind of emotional baggage I picked up on this path, and the only way I know to heal from it is to put it out in the universe by sharing it on my blog—where my family, friends, and even complete strangers get to read some of my most intimate thoughts.

I have no qualms about oversharing when it comes to my well-being.

So here’s the deal. On February 2, I had fibromyalgia. Then on February 3, I had a six-centimeter tumor on my brain stem.

On February 2 the general consensus among my doctors was that I wasn’t eating right or exercising enough. If I were, I’d experience improvement and maybe even remission of some of my symptoms.

On February 3 the general consensus among my doctors was “Holy, shit. You shouldn’t be able to do that” or “No wonder your body can’t walk, breathe, sleep, digest, or stabilize your heart rate and blood pressure like a healthy person.”

At first I was like, damn I am one tough cookie.

And then I was like, wait just a goddamn minute here.

I want to point out that from a purely physical experience, there was no discernible difference for me between February 2 to February 3*—even though in that 24 hours, my list of symptoms was suddenly more than validated.

Medical professionals (not speaking of specific doctors right now, just medical pros as a community) who were previously dismissive of my pain were suddenly losing their shit over how believable my reports of chronic pain and disability were.

And this is a point that I really want to drive home, so I’m going to repeat it:

The physical experience of living inside this tired, broken body didn’t change one iota for me in that time.

Still, somehow I went from being a whining, complaining exaggerator with two X-chromosomes to a human being who really had been experiencing unrelenting level-eight pain for TWO AND A HALF FUCKING YEARS.

charlie_brown_pain_scale

(My Spoonies are grabbing tissues right now, they are empathizing so hard.)

(Others might not quite understand just how much emotional damage was done. That’s okay.)

It makes me angry that I wasn’t taken seriously. It makes me sad that treatment (and possibly relief) could have come just a little bit sooner for me, but instead I spent months homebound.

The lazy-ass rheumatologist that was a little too eager to diagnose me with fibromyalgia in 2014 fought me over my symptoms and complaints of weight gain, insisting that I wasn’t exercising enough.

When I told him that I’d been tracking my steps, walking to and from work, walking three laps at the park after work every night, and using my FitDesk and hand weights at home and was experiencing physical decline instead of improvement, his response was “Well, you need to start out slower and build up.”

SERIOUSLY?

That’s all the motherfucker had. I must have been doing it wrong.

Now that I have proof of this brain tumor and I’m recovering from surgery, chemotherapy, and radiation therapy, I hear admonishments not to “overdo” when I tell the doctors and nurses that I’m walking without mobility aids or putting in 30 minutes (on the lowest resistance setting, for the love of god) on my FitDesk as I try to recover.

If you don’t immediately know why both of these experiences fill me with boiling rage, I’ll tell you: NEITHER VALIDATES THAT I KNOW THE PHYSICAL LIMITS OF MY OWN DAMN BODY.

And yeah, the anger that comes with that weasels its way into my waking hours from time to time. You got a problem with that?


*I implore you to think about this before you accuse someone with a fibromylagia diagnosis of being an attention-seeker, a pill popper, or a conjurer of fake maladies.

My First MRI Results

My First MRI Results

These are the MRI reports my primary physician had in-hand when she broke the news to me on February 3, 2017 at 1:30 p.m. that I had a brain tumor.

I’ll write more about how that experience went and how it affected me later. But for now, here’s the medical science-y stuff.

That’s a wiki commons image down there and not an actual image of my gray matter.

MRI BRAIN WITH AND WITHOUT CONTRAST 02/02/2017 16:13
——————————–
COMPARISON: None

INDICATION: Weakness, clonus, abnormal gait

TECHNIQUE: Sagittal and axial T1, axial FLAIR, axial T2, axial SWI, axial DWI, and axial and coronal T1 post contrast sequences were obtained through the brain. Gadavist 9 mL was administered intravenously.

FINDINGS:

There is a T2 hyperintense fusiform expansile mass involving the entirety of the medulla and extending inferiorly into the upper cervical spine spinal cord to at least the C2-C3 level. The mass extends superiorly to involve the inferior dorsal pons including the right facial colliculus. The mass measures approximately 6.0 cm x 3.0 cm x 2.7 cm (CC, TV, AP). The mass demonstrates predominantly facilitated diffusion and little to no enhancement. Because of the expansile nature of the mass, the cisterna magna and subarachnoid space in the upper cervical spinal canal are effaced. The V4 segments of the vertebral arteries are draped along the lateral aspects of the mass.

The ventricles are normal in size and position. The supratentorial brain parenchyma is normal in signal intensity. There is no acute infarct or intracranial hemorrhage. No enhancing lesions are present in the supratentorial brain. The major intracranial flow voids are patent.

The orbits are normal. There is a small mucous retention cyst in the inferior left maxillary sinus. The mastoid air cells are clear.

IMPRESSION:

Large infiltrative astrocytoma involving the medulla, upper cervical spinal cord, and inferior dorsal pons as described above. The inferior extent of the tumor is demonstrated to better advantage on the cervical spinal MRI performed today.

Neurosurgical consultation is recommended.
REPORT FLAGGED FOR PROVIDER ATTENTION.

Gray 111 - Vertebral column-coloured labels


MRI CERVICAL SPINE WITH AND WITHOUT CON 02/02/2017 16:00
—————————————————————————-
COMPARISON: None

INDICATION: Weakness, clonus, abnormal gait

Technique: Sagittal and axial T1, sagittal and axial T2, sagittal STIR, axial 3-D GRE, and sagittal and axial T1 postcontrast sequences were obtained through the cervical spine. Gadavist 9 mL was administered intravenously.

FINDINGS:

A 6.2 cm x 3.0 cm x 2.7 cm (CC, AP, TV) infiltrative intra-axial and intramedullary mass expands the medulla and upper cervical spinal cord resulting in effacement of the subarachnoid space from the cisterna magna to the level of C2. The mass extends from the pontomedullary junction to the C2-C3 level and demonstrates T2 hyperintensity and T1 hypointensity. A few subtle wispy areas of enhancement are suspected, but the majority of mass does not enhance. The mid and lower cervical spinal cord is normal in signal and morphology.

The cervical vertebral bodies are normal in signal, height, and alignment. The craniocervical junction is intact. The prevertebral soft tissues are normal.

C2-C3: The intervertebral disc is normal.

C3-C4: There is mild left uncovertebral joint hypertrophy without central spinal canal stenosis or significant foraminal stenosis.

C4-C5: There is a small central disc protrusion without central spinal canal stenosis or foraminal stenosis.

C5-C6: A broad-based central disc osteophyte complex causes mild central spinal canal stenosis. Uncovertebral joint hypertrophy causes mild left foraminal stenosis.

C6-C7: There is disc space narrowing, a mild diffuse disc osteophyte complex, mild uncovertebral joint hypertrophy, and mild Modic type I endplate change. There is mild central spinal canal stenosis. There is no foraminal stenosis.

C7-T1: The intervertebral disc is normal.

IMPRESSION:

1. 6.2 cm x 3.0 cm T2 hyperintense fusiform, expansile intramedullary mass involving the upper cervical spinal cord and medulla consistent with a brainstem and spinal cord astrocytoma.
2. Mild cervical degenerative disc disease including mild central spinal canal stenosis at C5-C6 and C6-C7 as detailed above.

REPORT FLAGGED FOR PROVIDER ATTENTION.

Cancer is Complicated

Something has given me an itchy rash from hell.

You know you’re in for a medically challenging day when your oncologist wants to take you off a drug you’ve never been prescribed and have never taken because it’s been known to cause a rash… and try a different one in its place. And then they send that Rx to a pharmacy 2.5 hours away even after you gave them the home pharmacy info.

::giant sigh::

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