Two years ago this November, I managed to total my car in the late afternoon. After having it towed and returning home, I took a nap. When I awoke I managed to then slip and fall down the stairs. All of this happened on the same day. The car crash was unsettling. I had never experienced an airbag deployment. I was fine, but the car was definitely not. I miss that car. The fall down the stairs was devastating. I lost it and began to wail uncontrollably.
The timing was terrible for the crash. We were leaving the next day for vacation. We were going on our annual trip to Austin, Texas for the Levitation Music Festival. Lots of walking and standing is involved. And here I was with a hyperextended, deeply bruised knee. I self-diagnosed and medicated. I used my knee brace from a similar injury in 2017 (a week before that year's vacation) and cautioned my husband that I would need to find places to sit and rest instead of standing and walking for hours on end. He was disappointed that I would be limited in mobility on vacation but understood. We found a place in Austin that provided acupuncture treatments and took advantage of that healing treatment on our first day there. Although in pain, the trip was enjoyable and a success.
Fast-forward to January 2020: I had a new-to-me car and still had pain and restricted movement in my injured knee. I needed intervention so I called my clinic for an assessment and referral to a physical therapist. My physician wasn't available, so I went with another doctor rather than wait. I'll call him Dr. X. (original, eh?) Dr. X had me do some range of motion and balance activities. He noted the swelling in my left knee versus my uninjured right knee and so we went on. He affirmed a referral for physical therapy, prescribed an oral medication for pain and swelling, and we agreed through casual conversation that I could stand to lose some weight. That was it. Nothing new or out of the ordinary. Office visit over.
I started the PT and attended for about six weeks, two to three times each week. The physio doc and assistants were great, encouraging, and challenged my fear of engaging with pain. I was able to build some strength and flexibility and in doing that my pain was greatly reduced. It was wonderful.
As the PT drew to a close, for some reason I opened my patient portal. I was looking at my chart and noticed an annotation from the January visit with Dr. X: Morbid obesity. Yes, I fit the data points for that diagnosis, but here it was in my chart. It was added by Dr. X., not my regular physician, and with no context or explanation around why he felt the need to add that particular point without conferring with the patient. Certainly my primary care physician could have put that in at ANY TIME. We actually talk about my weight and depression at each visit. I was angry. I was hurt. It was a slap in the face. It was unprofessional.
I carried that with me until just this month. Yes, I know, my Zen-master husband would be counseling me to leave that s*!t behind. But my carrying the matter wasn't so much personal, rather I was more concerned about someone else receiving the same deeply personal information without conversation. I had a medical emergency this past weekend which required a follow up (I'm OK and am going to be OK) but the only person within my leave from work that I could see was Dr. X. Seeing Dr. X was likely to help with my anxiety levels if I could bring myself to share the impact of the charting without context. So, I practiced my words, I asked for prayer and support, and girded my "speaking to power" loins in preparation for this early morning office visit.
We focused on the condition at-hand and once that was wrapping up, Dr. X stood and asked the "is there anything else?" question. "Yes, in fact there is, Dr. X. I would like to ask that in the future when you chart something into a patient's medical record that you have the conversation with them as well." He was uncomfortable and wanted to sit back down, but couldn't quite. When I went on to provide the detail as described above, he had a response that was somewhat hedgy and somewhat apologetic. His PA had the best look on his face which was a bit of, "Good Lord, what's about to unleash here?"
The explanation offered by Dr. X was that the charted diagnosis wasn't judgmental, but rather a response to a national initiative to track and control the obesity epidemic. He went further to indicate the charting software performs a calculation of weight and height to automatically enter that information. I responded politely, with tears of anger and frustration in my eyes that it still matters that context is provided and that no one going forward have that experience. I stopped the conversation there, and said I didn't need any further response, again stated that this situation should never happen again for other patients, and I thanked him for the response he gave.
In hindsight I need to give Dr. X the benefit of the doubt--it was a January appointment, the software could have updated, he might not have known about it at the time. However, the level of discomfort on his part demonstrated that he must rarely encounter patients who speak back and ask for transparent and quality, caring appointments. His final words were that I would need a follow up on the condition at-hand in a month and that I could have an appointment with him, or certainly could see my primary care physician. Indeed, I will see my regular physician.
Speaking back to medical professionals who are too clinical, cold, or fast in meeting with us is something we as patients don't often do. Asking questions is our right. Clarifying information we receive and share with our physicians is our responsibility--at the end of the day we are responsible for our health and we can't be so without understanding what our doctors are telling us.
Here is an example where I needed to ask for clarification during this most recent appointment. Dr. X used some language that wasn't clear to me when talking about a medication I would need to begin. I asked him to clarify, and he skipped way back in the conversation to explain two medical conditions that didn't apply to me. I stopped him again, and said, no, I wanted clarification about the medicine and its impact on my body. He explained and I thanked him. Here, he said, "No, of course. It's my job to explain these things."
If you are reading this and are hesitant to ask questions of your physician, please work on finding your voice. It is the physician's job to share information in a way you can understand. If you are unable to hear and understand medical information on your own, please ask a trusted friend or family member to be your ears and voice during appointments. You have this right to ask the questions you have. You may feel that you don't have the words to ask the questions, but start by saying that, "I need more information but I don't know what question to ask." is a find place to begin. The doctor or physician's assistant can help you find the words.
If your treatment during your visit has been unacceptable to you in any way, you must find your voice and speak to power at the doctor's office. Speaking to power isn't about being rude, angry, or loud, but it is about stepping into that space where we exercise our rights when someone holds power over us by position or knowledge.
