When Self-Doubt Became a Symptom of My Chronic Illness

Nurses are taught to assess pain as the fifth vital sign — right after heart rate, respiratory rate, blood pressure, and temperature. However, without an identifiable cause for pain and without concrete physical signs to support the symptoms, it is easy to “explain it away.” Medical professionals are not the only individuals who may explain away pain. Patients may even be more likely to dismiss or mask pain because of the fear that the pain is not “real.”

I injured my right foot a few weeks ago. I ignored the pain for a while, told myself I was overreacting. I ran slower and less often, and then I switched from running to using the elliptical. The pain continued. I worked on my feet for 12 hour shifts for weeks before I went to the orthopedic. I even told the licensed practical nurse who completed my history at the beginning of the appointment, “It’s probably nothing.”

The orthopedic suspected tendonitis, recommended an ultrasound in a few weeks, and prescribed a cortisone injection after the ultrasound. I continued to work right up until I had to call my husband to pick me up in the middle of my walk home from work because the pain was too bad to walk the last half mile. My husband is the person who pushed me to contact the orthopedic and tell him the extent of the pain and swelling that I was experiencing. The orthopedic moved up my ultrasound, provided me with a walking boot, and later identified a stress fracture. If my husband had not literally sat with me while I emailed the orthopedic about my worsening symptoms, I would have continued to “deal with” the pain for weeks.

I blame my tendency to explain away pain on my experiences with invisible illnesses. Because my physical appearance is not impacted by postural orthostatic tachycardia syndrome, my extended absences in my school years were often met with skepticism. My postural orthostatic tachycardia syndrome symptoms were dismissed altogether for months, at one point even attributed to “woman problems,” before my primary care physician fit all the pieces together and provided a diagnosis. These experiences taught me to doubt what I am feeling. Maybe my pain tolerance is not is high as I thought. Maybe the pain will go away by the time I even schedule an appointment with a doctor. Maybe there is no explanation for my symptoms. Maybe it is all in my head. And there is the biggest fear of all – the idea that my very real pain is actually a product of my psychology.

I try to reframe this issue through the perspective of a nurse. As a pediatric nurse, my patients cannot always verbally express their pain. Nurses use a variety of pain scales, vital sign changes, and patient-specific indicators to identify, treat, and then evaluate pain. Pain in the pediatric world is not as often questioned in younger children. However, I have seen older pediatric patients deny the extent of their pain because they did not want to interrupt me during a particularly busy shift. Somewhere along the line, these children adopt a fear of being selfish or impolite for expressing their pain, not at all dissimilar from my tendency to ignore my own discomfort.

Self-doubt that prevents an honest conversation between patients and their medical professionals seriously impacts the quality of healthcare. An individual should never feel as if they are required to validate their pain, whether a physical cause is identified or not. In the medical field, it is easy to be distracted by the numbers — lab results, vital signs, and pain scales just to name a few. While numbers may be useful for assessing pain and evaluating the effectiveness of treatments, they should not serve to validate a patient’s symptoms.

Medical professionals, we need to be more accessible to patients and invite them to share their symptoms and avoid using numbers to cast doubt on our patients’ experiences.

Patients, we need to be more forward with our medical professionals and more honest with ourselves.

Self-doubt should not be a symptom of chronic illness.

Getty Images by AlessandraRC