Communicating with Doctors.

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Jim Smith, modified 1 Year ago at 6/11/22 6:54 AM
Created 1 Year ago at 6/11/22 6:54 AM

Communicating with Doctors.

Posts: 1639 Join Date: 1/17/15 Recent Posts
I am wondering if anyone else has this problem or if anyone has suggestions...

When I go to the doctor I have a hard time communicating the severity of my symptoms. I think it is because of the effects of my meditation practice.

I don't appear to be suffering in proportion to the discomfort I'm actually feeling so the doctors underestimate the severity of my symptoms. 


Thanks
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Chris M, modified 1 Year ago at 6/11/22 8:12 AM
Created 1 Year ago at 6/11/22 8:12 AM

RE: Communicating with Doctors.

Posts: 5117 Join Date: 1/26/13 Recent Posts
When I go to the doctor I have a hard time communicating the severity of my symptoms. I think it is because of the effects of my meditation practice.

Jim, please say more - I'm not sure what you mean. Has meditation affected your ability to communicate adequately or your ability to experience more severe symptoms? 

Personally, seeing doctors has become easier/better for me since I've been meditating. I find it easier to communicate my symptoms because I'm less bound up in "my" suffering and more objective. I can also endure more in the way of treatment because I can better isolate difficult feelings and pain.
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Jim Smith, modified 1 Year ago at 6/11/22 12:51 PM
Created 1 Year ago at 6/11/22 12:42 PM

RE: Communicating with Doctors.

Posts: 1639 Join Date: 1/17/15 Recent Posts
Chris M
When I go to the doctor I have a hard time communicating the severity of my symptoms. I think it is because of the effects of my meditation practice.

Jim, please say more - I'm not sure what you mean. Has meditation affected your ability to communicate adequately or your ability to experience more severe symptoms? 

...


If someone says, "Doctor, my stomach hurts." The doctor will have a different interpretation if the person is calm or if the person is showing signs of stress. And different people may use different words to describe the same physical sensation depending on their level of psychological suffering.

Compared to a non meditator experiencing the same discomfort, someone who meditates a lot will suffer less psychologically and therefore will 1) not appear to be suffering as much and 2) will use more neutral descriptors to describe their symptoms.
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This very moment, modified 1 Year ago at 6/11/22 7:51 PM
Created 1 Year ago at 6/11/22 2:59 PM

RE: Communicating with Doctors.

Posts: 71 Join Date: 7/6/17 Recent Posts
       Most doctors are going to use your self reporting of symptoms as only part of the information they use to give you a diagnosis.  They are going to a variety of other information from your HPI ( history of present illness ) such as timing of symptoms, duration, frequency, mitigating factors that help/hurt the symptoms, etc.  All of this information goes into them formulating a course of action.  Self reporting of symptoms can actually be very unreliable and as a practitioner you have to get into the details.   For example, as a Dermatology PA I see dozens of patients that come into the office for an "itch".  Some people are really quite distraught by the itch and will say things to me like " This is driving me crazy, it is all the time, I am scratching myself to death, nothing works "   So I examine them and ask lots of questions.  When does it itch the most? morning, night?  Anyone in the family itching?  Is this the first time you have had the problem?  Did it ever happen before?  When it happened before, what was going on?  Have you changed any medications recently? New personal care products?  Take up any new hobbies?  get a new job?  Go away on vacation recently?  Give me a rating of your itching on a scale of 1-10.... 10 being the worst itching you have had in your life.   Can you sleep at night easily with this itching?   The nice thing about Derm is that the skin really tells me a story and I can change my questions on the fly as I look at the skin and know what is things cause the skin changes I am seeing.  A good physical exam and the right questions in taking the history help to make the likely diagnosis.  Then the treatment has to be right, and the patient has to follow directions those directions.   Then we follow-up in a few weeks.  The first question I ask " Are you better, worse, the same?  " Then the second question is " Where you able to get the medication and follow the directions I gave you? "   Lots of things can go wrong in practice and it can sometimes take time to get the diagnosis, treatment, and clearing of the condition right.    I encourage you to write down as detailed an account of your symptoms as possible with timing, your perceived severity, which medications you have used ( bring them ), etc. 
      Perception of symptoms such as pain, itching, burning, etc. is so variable.  As is tolerance for minor things wrong.  For example, I can have a two people come in with half of their body covered with eczema.  One person is jumping out of their skin, in tears, just wanting it to end.  This may be that persons first episode of the condition.  Another person has the same presentation and they are rather stoic, maybe had the condition for awhile.  They aren't as agitated so their perception of the symptoms are not as acute.  ( Perhaps they have a culture that encourages "endurance"  like Eastern European Catholic women.  Some of them offer up their pain and use it transformatively. )    I am not going to treat either patient differently according to the presentation in this case.  There is a fire that needs to be put out.  There are many times when I will not treat patients equally, however.   One of the most important questions to ask is " How much is this symptom/disease disrupting your life?  If it is a chronic disease state that will eventually resolve like Acne, we have to decide how agressive we will be in treating it.  Discussion of medication side effects/benefits follows and we agree on how to proceed.  If you want to DM me with your symptoms, I might be able to give you some guidance.    

Quote If someone says, "Doctor, my stomach hurts." The doctor will have a different interpretation if the person is calm or if the person is showing signs of stress. And different people may use different words to describe the same physical sensation depending on their level of psychological suffering.

    Sometimes but not always.  There are many patients that come in with psychological issues like anxiety ( about 30-40% of my patients!) that just completely blow their symptoms out of proportion to the seriousness of the condition.  In fact, many patients don't have a problem, they just think they have a problem and they are very distraught by their non-problem.  I.E. elderly patients in their 80's with dry skin or benign skin growths.  There is clearly suffering and a problem going on, but it is not a physical one.  Moisturizer, assurance that age related changes are normal and expected, some compassion go a long way to help those folks.  A thirty year old with body dysmorphic disorder going to pieces about a tiny imperfection on his/her arm that is not visible for me with a magnifying scope will not change my interpretation of what is going on.  A calm stoic person that says calmly I have a small black mole that is changing on my arm gets a biopsy to determine it is not a life threatening melanoma.  

​​​​​​​     If your doc is even mildly competent, he has an algorithm burned in his brain outlining " Approach to the patient with stomach pain " He will follow a step wise progression to rule out the worst case scenarios, regardless of your perception of symptoms.   If you don't get better, give him a couple appointments to try some things, run tests, etc.  If it doesn't work, get a second, third, fourth opinion.  Doctors are just people doing the best they can in an imperfect, for profit " health care system".      
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Jim Smith, modified 1 Year ago at 6/11/22 7:59 PM
Created 1 Year ago at 6/11/22 7:45 PM

RE: Communicating with Doctors.

Posts: 1639 Join Date: 1/17/15 Recent Posts
This very moment
Most doctors are going to your self reporting of symptoms as only part of the information they use to give you a diagnosis.
...

Thanks, that was interesting.

Just to clarify for other readers: I am asking, if you are the person who isn't showing a lot of outward signs of suffering and has a hard time describing the severity of the problem in the absence of psychological suffering, what did you say to the doctor? How do you communicate to the doctor the severity of the problem?

Does anyone have this issue? Were you able to resolve it? What did you do?

Thanks
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This very moment, modified 1 Year ago at 6/11/22 8:05 PM
Created 1 Year ago at 6/11/22 8:05 PM

RE: Communicating with Doctors.

Posts: 71 Join Date: 7/6/17 Recent Posts
Sorry if I didn't directly answer your question or missed the point of it.  

There is no way that I know of that you can communicate the severity of your symptoms to a doctor other than " My stomach hurts, etc. "  Unfortunately, we are somewhat limited by language.  

If you think that your meditative attainments have allowed you to turn the pain and suffering dial down to a really low number ( which is very possible )  it still does not change anything with your interaction with the doctor.   The person will do the best they can to get to the bottom of it.  If you have that serious a problem, I think your body will eventually develop some physiologic responses of stress that the doctor will pick up.  

Do you feel you are getting the run around and the doctor is not taking your complaints seriously?   Or is this more a dharma related philosophical question.  I.E.  if you put an arhat in a hot tub with a beautiful woman would he get an erection and how could he possibly be an arhat if he showed this physiological response? 
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Chris M, modified 1 Year ago at 6/11/22 8:35 PM
Created 1 Year ago at 6/11/22 8:35 PM

RE: Communicating with Doctors.

Posts: 5117 Join Date: 1/26/13 Recent Posts
I.E.  if you put an arhat in a hot tub with a beautiful woman would he get an erection and how could he possibly be an arhat if he showed this physiological response? 

Which, of course, is nonsense.
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Chris M, modified 1 Year ago at 6/12/22 7:20 AM
Created 1 Year ago at 6/11/22 8:29 PM

RE: Communicating with Doctors.

Posts: 5117 Join Date: 1/26/13 Recent Posts
No matter one's status along the path, pain is experienced as pain. One's reaction to the pain can vary but the physical intensity of the pain remains.

My doctors have a chart on the wall in every exam room. The chart shows a series of faces that exhibit increasing degrees of pain from one (no pain) to ten (unbearably intense pain). Patients can point to the face on the chart that best represents their level of pain in that moment. These charts are meant for children and folks who can't communicate well or don't speak a language understood by the doc, but they'll no doubt work for anyone.
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This very moment, modified 1 Year ago at 6/11/22 9:01 PM
Created 1 Year ago at 6/11/22 9:01 PM

RE: Communicating with Doctors.

Posts: 71 Join Date: 7/6/17 Recent Posts
That is called the Baker-Wong pain scale and adding pain help to usher in the concept of " pain as the 5th vital sign " .  This is partly responsible for the opiod epidemic because of the emphasis on treating all pain.  If I dug into it a bit, it would not be surprising to find physician researchers who were compensated by drug companies to develop the pain scale.  

By the way Chris, I am microbuddha over on Awakenet.org. 
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Chris M, modified 1 Year ago at 6/12/22 7:21 AM
Created 1 Year ago at 6/12/22 7:21 AM

RE: Communicating with Doctors.

Posts: 5117 Join Date: 1/26/13 Recent Posts
By the way Chris, I am microbuddha over on Awakenet.org. 

Aha! Thanks for letting me know.

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