The Patient Will See You Now: Part 1

When I was asked recently to become a regular contributor for the AJMC Contributor Page, I jumped at the opportunity, because my hope was to provide food for thought and a different perspective for the many healthcare providers who regularly read The American Journal of Managed Care. For this month’s post, I’ve decided to share a highly personal experience, because I truly believe that if it helps to change the way even a single healthcare professional approaches his or her patients, my story may make a positive difference for that provider’s patients—and for that provider as well.

“… Indifference means solitude. Those who are indifferent do not see others. They feel nothing for others and are unconcerned with what might happen to them. They are surrounded by a great emptiness. Filled by it, in fact…”

~Elie Wiesel

“Anecdotal evidence abounds in the form of patient stories regarding demeaning, disrespectful, and dismissive treatment…Patients may describe this treatment in a number of ways: ‘He treats me like an idiot,’ ‘He makes me feel like I’m wasting his time,’ ‘She won’t return my calls,’…or ‘It was clear he doesn’t like people who ask questions.’ Not only does such behavior violate the fundamental obligation…to provide support and healing, it can be devastating for the already-apprehensive patient.”

Disrespectful, Dismissive, and Indifferent

Like every other woman I know, I have always hated going to the gynecologist. It’s uncomfortable, and though I shouldn’t feel this way, I find the whole thing embarrassing. But the first time I had my annual visit with my gynecologist after having undergone my bilateral mastectomy was truly a horror story.

For weeks in advance, I dreaded the appointment. And on the day of the appointment, I was in full-blown pity party mode. But I had what I think are darn good reasons for feeling sorry for myself—reasons that I typically push away or fully repress, but that refused to be ignored that day. This was going to be the first visit when the “breast exam” really wasn’t going to be a true breast exam—because I no longer had “real” breasts. Rather, I had reconstructed breasts with implants, the result of immediate reconstruction after bilateral mastectomy, months of treatment with tissue expanders, and a second surgery to place the silicone implants.

I also dreaded sitting in the waiting room, where there almost always was at least one pregnant woman waiting for a prenatal visit with the Ob/Gyn. Thanks to the chemotherapy that I’d received for Hodgkin’s lymphoma in my early 20s, I’d learned many years later that I wasn’t able to conceive.

So I had reconstructed breasts, and I couldn’t have children—so the whole idea of having to go to the gynecologist felt ridiculous, and that made me angry. Of course, I knew that I still had to have my annual visits for optimal health, but I felt odd about the whole thing, like I was an imposter. So I was resentful, irritated, and worst of all, very very down, because all of this made me feel empty inside.

But the visit itself was even worse than I expected. It began as it always does: there was a pile of paperwork to fill out, something that always annoyed me, because I’d been a patient with the same gynecologist for over 20 years, but they still made me complete it all over again every year. And then there was the never-ending wait. I liked my gynecologist a great deal as a person: in fact, he was a family friend. But not once was I taken into the exam room at the scheduled time of my appointment. And when I finally did get into the room and changed into that terrible gown, I always had another lengthy wait—but this time wearing only the gown, which made this second wait that much worse than the first.

So I finally walked into the exam room, changed into the gown, sat down, and prepared to wait. A nurse typically came in before the doctor to ask about prescriptions and to take the patient’s blood pressure. When one of the nurses finally entered my exam room, I was relieved because I just wanted the whole thing to be over. And then she said it. She was holding my chart and some forms and, with barely a glance at me, she plopped my chart on the counter. She then hurriedly tried to hand the forms to me, but I was too busy trying to keep my gown closed with both of my hands. I reluctantly let go with one hand to take the papers, as she said in an obviously distracted, hassled tone, “So as you know, of course, the top form is for your annual mammogram…”

What? Did she really just say that to me?

Be sure to return on October 1st, 2015, to read part 2 of this post.