In 2022, I sought out mental health care, finally able to say, “I need help.” During this experience, my doctor’s brain churned, and a new patient’s brain grew. These allowed me to see both sides of the world of medicine, and the contrast, unfortunately, disappointed me. Below is a spur-of-the-moment writing inspired by a series of unfortunate patient experiences. In sharing these words, I hope I can help the patients who need to relate and the physicians who may have acted in dismissive or demeaning ways, likely unintentionally and unaware. I feel shifts in my ways of practice due to my experiences, and I hope to offer these tidbits of wisdom so that maybe others can learn from them and not have to live through them.
It shouldn’t be this hard to be believed, to be heard.
Others are so ready to say the victim is lying, exaggerating, and manipulating. They are not ready to say the perpetrator is lying, minimizing, or manipulating.
One of the greatest struggles and lessons in this patient experience is how little impact a patient’s words seem to have on her care. As a physician, my words make things happen with little question or doubt. In fact, due to my approachability, I probably get more questions than most physicians. Think about when one speaks to a physician, a cop, or a commander. Does one stop and question every word, wondering at the intent behind it? No. The intent is assumed to be in the best interest of whomever the words are about. The physician intends to heal. The cop intends to keep safe. The commander intends to lead.
The patient, however, advocating for themselves, is questioned. What did she really mean by that? What is she really trying to get or gain? Is she even trying to get better? Does she even understand what is going on?
I have heard so many dismissive comments from colleagues and made those comments myself. She is just borderline. She just doesn’t want to get better. She just doesn’t want to hear it. She isn’t even trying. She just wants disability. She just wants a scooter. She just wants pain meds. She just wants meds so she can keep up her bad habits. And on and on and on.
Now, I am the target of such comments. The most hurtful being, “She is just being difficult.” These statements make me feel unheard and unloved, as if I cannot be helped, like a burden, unworthy of others’ time, unworthy of treatment, and unworthy of getting better.
It turns out all those statements are a projection of our frustrations as physicians, not the patients’ intentions or feelings. The patient is trying her best. Her best may not seem like much, but no one gets up and says, “I want to stay sick today.” If we think along the lines that everyone is trying their best, the comment becomes, “What barrier is she experiencing that I am missing?” That is the right question, the appropriate statement that helps the patient instead of dismissing and demeaning her.
Stephanie Degen is an internal medicine physician.
