…and want to flee the exam room ASAP.
I do not take any pleasure in stating the obvious, but here goes: your Endocrinologist is a human being, just like you. She has strong opinions, moods, stress, hot-button issues, biases, and bad days. There are certain recurrent aspects of patient interactions that drive her absolutely insane; recognizing this universal truth, do what you will with the following insider tips, guaranteed to result in a terrible doctor-patient experience:
1. [Smiling beatifically while gazing soulfully into your doctor’s eyes] I am so glad to finally be here…
Allow me to set the scene: it’s your first visit with this doctor. She’s probably already had a rough day by the time you make it into the office. Knowing this, you want to set her mind at ease that this visit – your visit – is not going to be like the visits with all those other unappreciative patients.
Everyone enjoys a little flattery, no? Your Endocrinologist certainly is not immune to it. By all means, go ahead and express your profound gratitude for being in the presence of a kind, thoughtful, and thorough physician. Make it clear that the Rheumatologist, Neurologist, Cardiologist, primary care provider, and the two other Endocrinologists you’ve seen over the last five years just weren’t that good at listening and didn’t seem committed to working with you to find an answer to the constellation of nonspecific symptoms that continue to plague you.
Emphasize that you’ve done your research, and based on patient reviews online, you know that this Endo is going to be your savior – your confidence is supreme and unwavering.
2. I just want to tell you everything, so you have all the information you need.
You’ve done your homework and know that this doctor is thorough. She will review decades-worth of your medical history, while patiently listening to you explain every whiff of a possible symptom that you’ve experienced over that time frame. Remember when you had that fleeting pain on the right side of your neck, once, 16 years ago? Could be important. Make sure you tell her everything.
It is critical that you get it all out on the table in the time allotted for the visit, so speak as quickly as possible, and don’t waste your brain bandwidth trying to relate anything in a chronological fashion. Your Endo has gone through medical school, Internal Medicine residency, and an Endocrinology fellowship. She’s been trained to sip from the fire hydrant, separate the wheat from the chaff – pick your metaphor – bottom line: if you vomit your entire medical history onto the exam room floor, she’ll deftly sort out what has made you ill, right?
Wrong. She’ll cut you off, step out of the room, order a few lab tests just to get you out of the office, and when those tests come back normal, she’ll send you a terse note advising followup with your PCP.
3. I know my body…
Nobody knows your body better than you. Sure, your Endo has seen hundreds or even thousands of bodies very similar to yours, but yours is special. Different. When something doesn’t feel right, there must be an explanation for it. If your Endo hasn’t found it, it’s clearly because she hasn’t looked hard enough. Reassure your Endo that you understand that your “normal” lab results may not be accurate, which is why your naturopath has been treating you based on symptoms – not numbers – with the shopping bag full of supplements you’ve brought along.
For bonus points, you can shave an extra few minutes off your visit by removing the supplements one-by-one from the bag, asking your Endo’s opinion about the utility of each (she’ll cut you off at bottle #2, turf the rest of it to her medical assistant, and tell you she’ll do some research on your supplements and get back to you – you’ll never hear from her). To demonstrate ultimate mastery of visit-shortening technique, ensure that 80% of the supplements are herbals with at least 5 syllables in the name.
4. I am very sensitive to medications.
This is the corollary to I know my body… Given that we’ve already established that you are special and different from the thousands of other patients your doctor has treated with the exact same medical condition, it’s not much of a leap to accept that the typical prescribed doses of medication will be too much for you. Make sure your doctor understands that you view the prescription as a suggestion, not an order. You have a pill splitter at home and will probably take 1/8 of that 25 microgram levothyroxine tablet for the first few weeks, just to make sure it agrees with you. After all, the last time you took a single dose of 1/2 pill, you had two weeks of chest pain, insomnia, sweating, heavy legs, foggy brain, and visual floaters.
5. I don’t eat that much. Everyone says I eat like a bird. I eat way less than my husband/wife/boyfriend/girlfriend/friends/boss/housekeeper and I still can’t lose weight.
Your Endocrinologist needs to know that your diagnosis of hormonally-related weight gain is preordained. It must be, because there has never been another person in the history of modern medicine who has eaten as little as you with zero to show for it on the scale. When your doctor probes a bit by asking you more about what you’ve eaten in the last 24 hours, the correct answer is “I haven’t had anything since dinner last night, which was 3 ounces of grilled salmon with 6 asparagus spears, and water.”
Make it clear that the pizza, beer, and cake you had the night before last night was only because it was your niece’s birthday. And the Big Mac with fries and a Coke you had for lunch last weekend was only because you were on a road trip. Oh, and the venti mocha at Starbucks yesterday morning was a rarity, only because you had to take advantage of your free birthday drink coupon. Under normal circumstances, you hardly eat anything.
6. I need my hormones checked.
You’re at an Endocrinologist’s office, so she should know exactly what you mean by that. But if she does ask for clarification, explain that you “just haven’t felt right for a long time.” If your doctor tries to draw you out further, allow your face to register irritation with how long this simple transaction is taking. Make it clear that you just want her to order “the panel.” For bonus points, bring a written list of all the tests you think she should order, based on what your sister (not a doctor) told you needs to be checked. To 10x your bonus, make sure that your list includes at least one of the following: reverse T3, MTHFR mutation, or a 24-hour salivary cortisol profile.
7. I prefer to treat things naturally, without medications.
Explain to your Endocrinologist that you were quite happy with your naturopath’s care, and the only reason you’re back in the Endo’s office is because insurance would no longer cover visits with the naturopath. Poo-poo your Endo’s concerns that your laundry list of “natural” supplements still need to be detoxified by the liver, and assume a dubious smirk when she explains that your nutraceuticals may actually be more harmful than the evidence-based, single medication that would directly address your medical condition.
8. Bitterly complain and perseverate for several minutes about the cost of prescription drugs like it’s your Endocrinologist’s fault…
…while simultaneously complaining that your Endo refuses to order hundreds of dollars worth of blood tests like your naturopath used to do for you every visit. Refuse to see the irony when your Endo points out that your naturopath preaches treating based on symptoms (not numbers), yet that naturopath routinely orders 7 pages of labs not covered by insurance, then ignores all of the normal numbers and “treats” your symptoms.
9. Quickly shoot down every suggestion your Endo makes regarding what you could do to manage your weight/sleep/mood/energy.
You already explained to your doctor in the first 5 minutes that you’ve tried everything. By making suggestions, your doctor is clearly calling you a liar; it would be advisable to truncate this futile visit as soon as possible.
10. Come back for a followup visit 1 year later. Explain that you didn’t take the medication your doctor recommended because you read up on it and the side effects are terrible; you didn’t do the sleep study she recommended because you don’t want to use CPAP; and you didn’t do the followup labs recommended on the after-visit summary because nobody told you to.
At this point, your Endocrinologist will be cringing internally while asking how you’re feeling now. It’s time to prove that you are the Zen Master of doctor-repelling: with equal parts consternation, accusation, frustration, innocence, and incredulity, you exclaim “I don’t understand why I feel just as bad!” For a moment, just let the silence do the work. Then, to really press your advantage, repeat the following at regular intervals, titrating the frequency of this statement to crushing of your doctor’s soul: “But there must be an answer!” Game. Set. Match.
Are you a physician who recognizes any of the above? Can you add a few more to make it a top 15 or a top 20? What makes you want to flee the exam room? What’s the worst interaction you’ve ever had in the room? If you’re a patient, what are the top few things your doctor could do to make the visit better?
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March 7, 2020 Update:
To my readers: while I wish you could understand that finding humor in the exam room is not mutually exclusive with having empathy, it is clear – after several years of comments – that many of you cannot. Sadly, the online environment has fostered the hardening of our sense that everything must be binary – good vs bad, if you will – to the exclusion of nuance.
I have left the comments section open on this post for years, as I always thought that allowing readers to chew me out might be cathartic for them. As you know, I like to help people in whatever capacity I can, so I’ve allowed it. I think, though, that the time has come to close the comments on this post. I no longer want to participate – through benign neglect – in further destruction of appreciation for nuance.