The New Patient

I saw this post at Ripple of Hope (formerly Difficult Patient) following the link from Grand Rounds. Edited and posted here with her permission:

The New Doctor

Well, she's new to me. She is Dr. Barbie, and I have an appointment with her today for a physical. I'm nervous. How much do I share with her? How much does she really need to know? How do I tell her not to ever give me sleeping pills or anti-anxiety meds or anything stronger than ibuprofen for pain--how do I tell her these things without telling her why?

There is no way I'm going to transfer my medical records from Dr. G. I have a personal copy of my official records (no, I'm not going to share it with her) but I can only imagine the negative remarks Dr. G would make about me.

Yep, I think Dr. Barbie would drop me like a hot potato if she ever spoke with Dr. G. I really wouldn't blame her, but those records do not accurately reflect me (then or now)--they are defensive assumptions because Dr. G didn't have all of the facts. Yes, I know it's my fault that he didn't have all the facts, but that doesn't exactly help me now. I think I'll keep my answers brief and to the point. I like her, but I don't know her, and I don't really trust her.

Yep, I'll just leave the past in the past for now. Any suggestions on how to communicate with my new doctor without scaring her away?

Here's my response (expanded upon from the comment I left on her blog):

I hear you. I'm the doctor on the other side of that door. I wouldn't dream of comparing my anxiety to yours; I'm well aware that I wield the tools of authority, pain and humiliation (white coat and stethoscope, needles and probes, stirrups and gowns.) But anxiety is contagious; and just seeing you check in at the desk and sit in the waiting room, your obvious nervousness surrounding you like a cloud of worried gnats, makes me nervous just to walk into the exam room. So I'll take a deep, cleansing breath as I open the door, and resolve to project enough serenity so that at least some gets back to you even through your anxiety.

I'll introduce myself and shake your hand; then I'll sit down, put your chart to one side, look you straight in the eye and say, "What can I do for you today?"

And then I'll listen. Talk as long as you need to; tell me whatever you want.

I'll want to know why you're really here; there's no such thing as "just a physical." New to the area? (Welcome.) Old doc died/retired? (Sorry about that; I'll try to pick up where s/he left off.) New insurance? (Bummer, but I'll do my best with the new plan.) If you had problems with other doctors I'll want to know about it, mainly so I can go out of my way to make sure you don't have another.

As for your medical history, I'd like to have all the information, but if you'd rather wait and see instead of dumping it on me all at once, that's fine. I can wait. I don't mind giving you the time you need to get comfortable with me. In fact, spreading the whole story out over several visits is easier on my schedule.

If you're playing me for drugs you're going to be disappointed eventually, but I'll give you the benefit of the doubt to start with.

As for communicating with Dr. Barbie, here's my suggestion: be yourself. Tell her whatever you want, however you want to tell it. If you scare her away then she just wasn't good enough to be your doctor. Then again, you may be surprised to find her competent, caring and understanding. Consider giving her a break; it's what you'd like her to do for you, isn't it?

(Back off, all of you in your time-stressed, seven-patients-per-hour-or-else practices. This is what I do and how I do it, because I can. What anyone else does is irrelevant. This is the stuff that seems to be going the way of the dinosaur.)