When the Doctor's Office Feels Like a Principal's Office

“Do you have a doctor back in Seattle that you like?”

“Yeah … sort of,” I replied.

“I would start there, then.”

Why was I so reluctant to return to my general practitioner (GP) from Seattle?

She had diagnosed my rare chronic condition, a condition other doctors had overlooked. I was a young woman in my mid-20s, complaining of headaches, nausea, dizziness. I was told that I had migraines and prescribed a variety of migraine medications that barely touched my symptoms.

I went months with intractable pain that rated an eight on a scale from one to 10. I remember driving home from work with tears streaming down my face because I hurt so much, and I was exhausted from working so hard to simply make it through the day. She diagnosed me and got me on a treatment plan, which took that daily eight down to a daily three.

She was the person who stuck with me and told me that what I was experiencing was clearly too serious to be migraines. When I passed out, alone, at home with repairmen, she quickly ordered an MRI, with contrast solution. A small but significant difference. The test, and the contrast solution, allowed for my Arnold-Chiari to be diagnosed. I am so grateful for the role she played in my healthcare.

She believed my condition was serious when no other medical professional did. She helped in concrete, verifiable ways.

So why did I have this nagging feeling, as I was leaving Austin, and my current general practitioner, that I did not want to return to her as the leader of my healthcare team?

When I returned to Seattle, I put off transitioning care as long as possible. I had prescription refills transferred to the nearest location of the national chain drugstore, and requested refills through my Austin doctor. I knew I needed to search for another provider.

I would get on Google and type in “Arnold Chiari expert Seattle,” but those doctors wanted referrals from a general practitioner. I would search for “general practitioners near me” and scrutinize bios and online reviews, looking for some magical clue that would tell me which doctor would be perfect.

I stalled like this for months until I received a call from the nurse of my former physician, back in Texas. She said, “Doctor X would like to know how your move is going and hopes your doing well back in Seattle. And he’s also wondering how your search for a new doctor is going.” It was the compassionate but firm push I needed to get my butt moving and transition my care into my current city.

I called my former GP, telling myself I had been imagining any problems. After all, she had helped me so much; she must be the right doctor for me.

An appointment as a new patient was going to take 12 weeks. While I waited for that appointment, I decided to also try another doctor in the area. So I had two visits scheduled — one with my former GP and on with a new internist.

First, let’s talk about the visit with my former doctor.

She walked into the visit, and it was like seeing an old friend. She told me I looked the same, and I think we both felt genuine happiness at seeing each other again. But when she started going through my medical records, I felt a shift from friendship and regard to paternalism and judgment. Without asking how I felt or how I was doing with my illness, she began judging medications I was on and ways I had been handling my disease. I felt defensive and flustered. And suddenly I knew why my instincts had told me not to return to this doctor.

When I left the visit, I felt less than equal, less than human. And I felt like I had done something wrong.

Now let’s talk about my visit to the new doctor. I ended up finding him a bit randomly because I had procrastinated my search, and he was close to me and easy to schedule an appointment with. He expressed a different approach to some aspects of my care, and asked if I would be open to changing, but did so in a way that included me in the process. It made me feel engaged and valued. As a result, I left that visit empowered and hopeful for the potential his idea for change could have to make me feel better.

One doctor made me feel like he was on my team, helping me get the care that worked best for me. The other made me feel like I was in a principal’s office, being scolded.

I have a tremendous amount of guilt over not seeing the doctor who diagnosed my condition now that I live in the area in which she practices. But I am learning to come to terms with the fact that, just because she was the right person to diagnose my condition does not mean she is the right doctor to manage my care long-term. She is without a doubt an outstanding doctor. She is just not a good fit for me for long-term care.

The whole situation also provided yet another reminder of why good communication is so essential between patients and practitioners. From a patient perspective, I was happier with after the visit with the doctor who had better communication with me. From a practitioner’s perspective, I was more compliant with his requests and will return to the doctor who had better communication with me.

I am so grateful for this doctor who diagnosed me. I struggle with my illness every day, but I struggle so much less now that I know what I am dealing with. I am learning to accept that gratitude for the part she played in my healthcare.

But these issues are so difficult. I do healthcare communication for a living. I have a PhD in health communication, and that doesn’t prevent me from leaving a doctor’s visit feeling shamed, like a child who has done something wrong. We need to prepare ourselves as patients to handle these situations better, but we especially need to teach doctors to be more compassionate of patients and their emotions. It’s easy to address a situation clinically and forget to think about the human being in the room with you.

Getty Image by lolostock