Recently I visited a doctor, who had a totally different view to my situation than any other doctor I've previously spoken with. I had never met her before, because my usual doctor is away, but I needed to make an appointment. I was unsure what to expect... but in the end she blew my mind.
Usually the visits start with "so what's going on with you?". She, sitting without her white jacket and dressed in a beautiful, greed blouse, started by chatting amicably about how she came to work there. I was nervous and thinking I'm severely ill, but she kept talking about how she left her previous job to make way for a new colleague. She even joked with my husband, who usually accompanies me but gets ignored 95% of the time.
(What the heck? I thought. Why are we chatting while I'm having serious symptoms here! Except .... of course I wasn't. She was putting me at ease and observing how well I was able to listen, to focus and to reason. )
Then, instead of asking how I was, she said she'd read "my story". She had taken the time to read about my previous visits and lab results. She had read the reason I've given for my visit.
By this time I had a suspicion this would 1) take forever, and 2) go either very well or very poorly. It turned out to be option 1 and it went very well. Here's what I learned.
Anxiety is useful
With several examples from the nature she reminded me that anxiety is useful. It's there for a reason. We'd be very much dead if we didn't fear anything and kept taking risks. Us humans are built to stay vigilant and react to our surroundings. It's not a problem. It's what we're supposed to do.
Anxiety is not "all in your head"
Anxiety as an emotion is all in our head, yes, but it's connected to our entire body. The sensations anxiety causes are very real and definitely not in our head. Her legendary comment "You cannot escape a predator with a full bladder. In a panic our bodies empty the bladder. When that happens, we really need to pee and not just mentally pee."
Your sensations are real. You are not crazy.
Whatever you feel is real, even if an examination cannot prove it. If your leg hurts, but an x-ray doesn't show a broken bone, you're still hurting. If your heart is skipping and pounding, but tests do not show anything abnormal in the conductance or structure of your heart, your heart is still skipping and pounding. If you're tired but bloodwork is all perfect, you're still tired.
That sensation is real and needs to be treated.
The patient must get realistic expectations.
Especially people with health anxiety and somatic symptom disorder like to expect all kinds of tests. The fact is that many times nothing useful comes out of the tests. You can get 1000 examinations and they will show nothing.
"Testing for the sake of testing is not helpful for anyone."
The symptoms / sensations still stay. The tests available just cannot show a reason for them.
This is really important to understand, before using medical tests as a safety blanket:
- a test can come back negative ("all good"), but it will not stop the symptoms.
- a test is never 100% certain.
- a test can reveal something that cannot be helped. It doesn't have to be anything serious, but it can be something the doctors just cannot do anything about.
- and once again, a test may show that all is well, but you will keep having the symptoms you do.
- tests only show what the doctor is asking for. An x-ray of your chest will likely come back with a comment "no broken ribs", unless the doctor had specifically asked to look for a dime you swallowed last week. Blood work can be "all good", unless you specify that you need to know the exact value of X for monitoring purposes.
The patient should be in charge of their health and treatment, not the doctor.
I had wanted a specific test for a long time. I thought it would put my mind at ease, and I was even prepared to do it on a private clinic via a commercial provider. When I mentioned this test, the doctor turned the tables. "Okay, then we'll do that! We need to plan it. Find out what your family medical history is. We need to think what our questions are, and then we'll arrange the test."
With those words I had a plan, and I was put back on the driver's seat of my own health. No more begging, no more hoping and me vs. the doctor. I was now working together with the doctor.
Recognize the impact on your family
Often my husband joins me at the doctor, because I tend to get nervous and not dare to speak up. This time was no different. Instead of ignoring him, the doctor involved my husband in the discussions. She listened to him, answered his questions, and provided comfort and confirmation. He is, indeed, impacted by my anxiety. The doctor verbally confirmed that he is doing great work by supporting me. She showed that it's okay for him to sometimes feel lost with me. She confirmed that his feelings are real and worthy.
And as a by-product she reminded me to do the same. To recognize his struggles in supporting me. To recognize his concerns and his needs.
And that's it!
By writing these down I hope I won't forget her lessons - and I hope that you, too, will find a doctor who will work with you.
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