What your doctor wishes you knew
I work with a lot of clients with complex medical presentations and intense health anxiety. I also happen to have a lot of doctors in my family and friend groups. I hear from my clients who often feel dismissed and let down by doctors and I also hear the struggles doctors have, coping with the concerns of some patients. Here is what I often tell my clients and what I wish the medical system could communicate to their patients:
Primary care is important. In order to have a functioning medical system, patient concerns have to be worked up in a coordinated and systematic way. Patients who seek to direct their own medical care by consulting multiple specialists without seeing primary care first are risking having common causes of diseases missed and are also clogging up specialist appointments, reducing access for everyone.
Follow-up is part of the process. We are not living in an episode of House where miraculous diagnoses and cures are cooked up in a day. Working up complex medical concerns occurs over multiple visits with multiple professionals looking at the patient, over time. Those specialists then have to coordinate as to not step on each other’s toes. That might mean visiting your primary care doctor, in person and then perhaps virtually, several times before a referral to a specialist is made. Then, it may take multiple visits to each specialist to ensure a thorough rule-out has been performed. This is normal. This is how the system is designed to work. Most people will not need all of these visits, but the more obscure the diagnosis is, the longer and weirder the workup is going to be. Keep taking the next step.
Health anxiety can occur even when objective medical disease is present. A doctor telling you that anxiety is part of your symptoms does not mean that anxiety is the CAUSE of all symptoms. It just means that anxiety might be making symptoms you already have, worse. A little bit of anxiety can motivate you to take the next step in your care but too much is counterproductive to your health. If a doctor says anxiety or mood is impacting your symptoms, they are not telling you that they refuse to work up any medical cause. They just think you’d probably suffer less if you could treat the anxiety while they work up the physical disease process.
Psychiatric medications are sometimes used for “medical” issues. Please don’t avoid the psychiatrist. Psychiatry can help with treating chronic pain, functional bowel disease, functional neurological disorders, migraine headaches, and a host of other medical issues. A referral to psychiatry is not the doctor calling you “crazy.”
If your doctor seems unequipped to deal with your social or psychological issue in a 20 minute visit, they probably are. Therapists get a full hour to work with clients on the mental health intersection of their medical issues. Physicians get 20 or so minutes, including documentation time. If they seem frustrated, it’s probably because they’re expected to help with a very complicated issue in an unreasonably short period of time. Therapists get more time. Come see us and we can work with your doctor to coordinate your care.