Stressful Doctor Visit: Part I

By: Loolwa Khazzoom, Founder, Dancing with Pain

April 14th, 2009 • Patient AdvocacyPrint Print

I am shaking. I’ve been shaking for the past eight hours, following my visit to a new primary care physician. On my end of things, I didn’t approach the appointment as proactively as I could have. I think it’s a combination of factors: For starters, I’m overwhelmed taking care of my mom, my work, and the administrative matters of my life, so I have not been thinking as clearly about or giving the time necessary for navigating through the medical machine.

Second, after half a year of living in Southern California and after two painful (literally) doctor experiences, I hit a point of desperation — both to establish a decent primary care physician on file and to get referrals to a few specialists I need to see ASAP. The doctor I saw today works closely with a local integrated medicine center. So he seemed like a wonderful candidate as a primary care physician, or at the very least, a great person to throw on my chart for now.  

Third, I’ve recently been so cloistered in my ghetto of fabulous body workers that it’s taken a few reminders to believe that a simple visit to a doctor can indeed be a traumatic experience. It seems so impossible, until it happens.

Now this doctor was not what I’d call a bad doctor. In fact, I think he embodies qualities that can make him an excellent doctor. It’s just that he dove in too fast for me, and it left me completely jangled. Had I come in better prepared, this scenario may not have happened. And yet, I think that health care practitioners need to take a step back in the first visit with a client, so that the burden of safety and pacing doesn’t fall on our shoulders all the time.

First, he grilled me for being 10 minutes late. I appreciate his concern that it meant we’d have less time together. To his credit, he wanted the full half hour with me, so that he could give me a decent amount of time. After paperwork was done, we had only ten minutes left.

And yet, he harped on this late thing several times. It’s like, buddy, life happens, people sometimes have crazy-ass shit going on in their lives, and they come late every now and then. Aside from which, how was I to know you’d be the one doctor in the universe who runs on time? I felt pressured to apologize about four times.

I told him I was fine with just getting some referrals and cruising outta there. In fact, that’s all I wanted! But he had other plans, despite my feedback. I think his intention was to give me the best possible care, even if crammed into a short amount of time. But he didn’t first consult with me or, when I verbalized it, actually listen to me about what that care might look like. So he ended up feeling rushed, and I ended up feeling pushed.

Within two minutes of grilling me, he was busy asking invasive personal questions about whether I had any history of abuse, and if so, what kind of abuse it was and whether it was with people I knew, specifically, family members. Again, I appreciate the sentiment: Child abuse certainly can be a major contributing factor to health problems, especially if left unaddressed. Very cool that a doctor who practices Western medicine is onto this notion. But to be jumping in with these intimate questions just minutes into the session, when I don’t know this guy at all, and immediately after chiding me for being late? How about a little warm-up here?

I didn’t want to answer his questions, but somehow, I felt I had to. No matter how informed and empowered I am, something about the doctor’s office environment kicks me into submission on some level or another, almost every fucking time. Especially if I am, well, sick (which is of course why I’m usually there in the first place), and my defenses are down.

I also think it’s because of a combination of other factors: I have invested X amount of time into the doctor research and/or visit; I have some health need (like a prescription or referral) riding on the doctor’s collaboration; and I ultimately want the relationship to work, so that I don’t have to go spending my life looking for another freakin’ doctor. Plus there’s that old obey-authority training that seems to be the fall-back emotion, coupled with the doctor’s attitude that he’s the boss, plus social expectations that I’ll fall into line. It all becomes a little much to push back against all the time.

So I robotically answer his questions, then try to shift the conversation to the issue at hand: I’ve had adult acne for years, and I really want to see an integrated medicine specialist who knows dermatology, so that I can get rid of my acne once and for all. He asks me questions about what I’ve tried in the Western world, and I make it clear I ain’t interested in any o’ that shit – topical solutions, antibiotic pills, none of it.

Without warning, doc man rolls his chair over so that his legs are pressed onto mine, and he’s all up in my face. I’m in serious physical discomfort. I don’t have time to register what’s just shifted, when he starts pressing hard on my left and right arms, showing me where I can stimulate acupressure points to heal the acne.

Again, “A+” on intention: Teach the patient non-invasive self-care. But “D” on method: I‘d very clearly told him I have chronic pain throughout my body. Any practitioner with that information needs to be very. fucking. careful. about getting into the client’s physical space. The practitioner needs to move slowly and gently, checking in with the patient – inviting her/him to speak up and regularly asking if any given pressure hurts. As a rule, the practitioner should start out only with super gentle touch. S/he can always amp up the pressure if it’s OK for the client.

So there I am, vibrating and panting inside from the sudden rush of stimulation coming at me. To my credit – hard-earned from years of navigating through the treatment of careless and/or clueless doctors – I instructed him to stop and move back and be super gentle with his pressure. He did get gentler, which I did appreciate. I couldn’t help but notice, however, that there was a bit of judgment – an incredulous, “Like this?!” — about how lightly I was asking him to touch my arm.

I’d barely recovered from the emotional frazzle of that string of events, when doc man jumped up, threw a flimsy gown on the examining table, and instructed me to take everything off, except my bra and underwear, and put the polka dot monstrosity on backwards. His hand was on the doorknob, and he was flying outta the room as he spoke. I felt a sinking sensation inside. Too much, too fast. And I felt that if I said something to the extent of, “No, I don’t want to be examined,” or, “Slow down, this is too much,” he would deem me a beligerent patient, and who knows what — maybe not want to work with me anymore, or just get all pissed and authoritative on me — for which I just didn’t have the fucking energy.

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