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If You're a Female Patient, You May Relate to This Advice From Jane Austen

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I recently read “Northanger Abbey” by Jane Austen. It is a spoof of gothic novels of Jane’s time, so I suspect I missed a lot of the humor. To understand it better, I’ve downloaded — free — some of the novels read by “Northanger Abbey’s” heroine, Catherine Morland. On that magical day when I’ll have time to read all the books I intend to read in this lifetime, I’ll be checking out “The Mysteries of Udolpho” and the works of Maria Edgeworth and Frances Burney.

I may be missing some humorous references, but I can appreciate as always Jane’s trademark sardonic wit. As her heroine walks the hills about Bath with her new friends, “She was heartily ashamed of her ignorance — a misplaced shame.” This leads Jane to observe generally:

Where people wish to attach, they should always be ignorant. To come with a well-informed mind is to come with an inability of administering to the vanity of others, which a sensible person would always wish to avoid. A woman especially, if she have the misfortune of knowing anything, should conceal it as well as she can.

Of course Jane meant this advice for women generally, but it is especially apt for female patients, particularly those among us who know more about our own condition than most doctors we encounter.

It is important to establish a good rapport with your doc, or your kid’s doc, if any given visit is to be a useful expenditure of time and money. To that end, I spend an excessive amount of time delicately dancing around doctors’ egos. Before I had an endoscopy, for example, I had to carefully interrogate my new gastroenterologist’s understanding of celiac disease. Were I to flat-out tell him how many biopsies to perform, he would have been offended, which would have affected our relationship going forward. But we have to have the conversation, as the literature says fewer than half of doctors take the recommended number of biopsies for a celiac endoscopy.

So I widened my eyes and asked — as if just out of curiosity — how many biopsies he planned to take? As if just incidental, you know. Because what you do for a living is so interesting, Mr. Handsome Doctor Man. Thank God, he gave me a correct answer, because had he answered otherwise, I would have had to say, “Silly of me, but I just remembered I happened to read it’s a good idea to take more than four biopsies during esophagogastroduodenoscopy. Did I read that in Glamour? No wait! What’s in my bag? “Guidelines for Endoscopy in Celiac?” Weird! How did that get there? I guess I’ll just leave these with you, Silly Little Me has no idea what to do with them!”

Because I live in the boondocks, the doctors I see most often are what I call Boon Docs. They kind of have to be generalists, because we don’t have the population to support doctors who specialize in one disease. They can’t possibly be expected to be experts in everything. Yet, many take offense when a patient must impart facts that are new to them – even from a patient who does have time to read deeply about that particular disease, while they do not. And God help you if you are a woman who must impart facts. Yet, impart facts you must, if their treatment is to be relevant and useful.

On one particularly harrowing occasion, when my child with the rare disease scleroderma en coup de sabre was hospitalized, I offended the hospitalist by accidentally uttering the Forbidden Phrase: “Are you familiar with it?” I was tired, I needed to know how much I needed to explain to him, and I failed to observe the niceties. The question just came out. As a result, he huffed, puffed, and became a major pain in the ass for the duration of her stay, even going so far as to question the judgment of her renowned rheumatologist, suggesting she was being “overtreated.” It’s amazing what insights an offended doc can find on Google in a quick search for a disease he’s never seen! Sarcasm aside, her treatment would have gone more smoothly if I had taken better care to protect his ego.

Administering to the vanity of insecure doctors is trying. Convincing doctors to “attach” to you, to care, to engage their intellectual curiosity and consider your case seriously enough to offer helpful ideas, is even harder. It is a balm that Jane feels our plight keenly.

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Lead photo courtesy of Aidar733 via Flickr Creative Commons

Originally published: September 17, 2017
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