I passed an unwelcome milestone of middle age not too long ago when I threw my back out for the first time. I reached down to close the dishwasher door and my back muscles began to spasm painfully. I could hardly walk, it hurt so much to move.
After the pain persisted for several hours, my spouse Glenn took me to the urgent care facility run by our managed care organization. I have been very pleased with my health care team in this organization for more than a decade – which made what happened such a surprise.
After a nurse took my vitals, she asked me to remove my shirt and put on one of their (oh-so-flattering) gowns, and then she left.
I was very pleased when a doctor arrived only a couple minutes later. Following a brisk knock, a woman strode confidently into the room. Shaking my hand briefly but not meeting my eyes, she introduced herself. (I’ll call her Dr. Distracted, not her real name)
“I’m Laura,” I responded, then gestured toward Glenn who was seated nearby. “And this is Glenn.”
“Hi!” she called over her shoulder, not making eye contact with him either. I sighed.
“Hello,” responded Glenn.
Moving rapidly to a computer screen, Dr. Distracted sat down and proceeded to scan my records. “So what brings you in today?” she asked.
“I think I threw my back out. I reached down to grab the dishwasher door, and my lower back started to spasm, and it really hurts whenever I try to walk or even move at all.”
“OK,” she answered, sounding distracted. She continued to stare at the screen in front of her. After a minute of silent reading, she added. “You seem to be on quite a bit of pain medication already.”
Was I imagining the hint of disapproval in her voice? Taking a deep breath, I nodded. “Yes, that’s for the phantom pain.”
“Phantom pain?” she asked, her voice sounding both bewildered and skeptical. Finally she looked me in the eyes. “Phantom pain where?”
I stared back at her incredulously. Not even trying to hide my frustration, I replied, “Um, in my missing limb?” With a flourish, I gestured to my full leg prosthesis, clearly visible in the harsh fluorescent lights.
Dr. Distracted looked at my body. “Oh,” she said. “I didn’t notice.” I glanced down at the purple and fuchsia striped pattern on my socket, the gleaming titanium knee joint, and the glossy black ankle of my prosthesis. I looked back at her, my eyebrows raised.
“Well, that’s a good thing,” she added. “It’s good that I didn’t noticed that about you.” She didn’t explain why, but she didn’t need to. I knew what she meant.
I weighed the value of educating the doctor against my urgent need for pain relief, and the pain won. I rolled my eyes at Glenn but declined to comment. I left a few minutes later with a photocopied sheet of back exercises and prescriptions for a muscle relaxant and an anti-inflammatory.
The list of ways in which this doctor annoyed me is extensive—no eye contact with me, not acknowledging my spouse, infusing her voice with skepticism when discussing my pain and medications, and then defending her failure to be even mildly observant by framing my disability as a stigma that I should be glad she hadn’t noticed.
So in the spirit of every patient who has ever figured out on the car ride home just what she should have said, here’s how I wish I had responded to this doctor:
“It’s hurtful that you would talk to me this way. The only reason it would be ‘good’ that you didn’t notice my disability is if that disability is something bad or embarrassing. I don’t need or want to hide my missing limb or my prosthesis. It is not a compliment to tell a patient that you didn’t notice something that is not only clearly visible but relevant to my diagnosis and treatment. And it’s not appropriate for you to express skepticism about my pain or medication needs when we have never met, and you don’t know my medical history. If something doesn’t make sense to you, please ask me questions respectfully, and I will do my best to answer them thoroughly and honestly.”