When Doctors Discriminate: Please Share!

I was denied pain medication after a major surgery (fusion of two intervertebral discs in my neck) because I wrote “Xanax” on my list of medications on the pre-op sheet, and it was assumed that I was a drug addict (a nurse told me so.) This was in 1987. Ever since then I have omitted my psych drugs when filling out a drug list, and have paid out of pocket for psychiatric care so it wouldn’t be on my records. Recently I stopped doing that because I take so many of them that it would be dangerous to mix certain of them with anesthesia drugs, and I have been treated markedly differently by hospital staff (“crank”) and doctors. In fact, doctors missed a major diagnosis, assuming that chronic diarrhea was “irritable bowel syndrome” when in fact I had none of the symptoms of that, and turned out (after I demanded genetic testing) to have a rare form of Cystic Fibrosis. I pick and choose which doctors I tell about my psych diagnoses on a “need to know” basis, because the stigma causes them to immediately assume that any symptoms I have must be “psychogenic” and therefore dismissed, or else I am denied pain medication on the assumption that I must be a substance abuser, which I am not and never have been.
There is a study (I don’t have time to search for it right now, but if you need me to I will) reported on Medscape for physicians documenting that people presenting to hospitals with chest pain received different care if they disclosed psych diagnoses than people who didn’t, had longer waiting times and increased morbidity and mortality as a result.

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8 Comments

  1. Did you read the comment I wrote to Kristen on the original post? I feel like death right now, you two need to get together and fight some stigma “for the Gipper.” 😉

    When my fever recedes and I am somewhat coherent again, perhaps we can integrate telling these stories through Canvas. I want to do more with it, right now is not that moment for me, though!

    Reply
    • I’m so sorry that your’re sick! Sending healing energy your way. No, I haven’t been back to Kristen’s blog. Hurrying to take my parents somewhere. Will do ASAP. I agree we need to do something on Canvas. I haven’t posted in a million years so I’d be happy to collaborate or do an independent post with medical articles embedded.

      Feel better!

      Reply
  2. Terrible and shocking that this happens!

    Reply
    • It is. We really need to go into medical schools and do some education. I used to do that when I was in my combined degree program, Medicine and Medical Anthropology, but that was a long time ago. Maybe it’s time to start doing that again.

      Reply
  3. dr12n12

     /  November 2, 2013

    WOW! I followed a series of tags to find myself here, and I find the bile rising in my throat I’m a residency trained, boarded Family Physician, and fellowship trained in Addiction Medicine and Clinical Pharmacology & Toxicology. I also have Bipolar-Type I. I’ve had several spinal surgeries (multiple level fusions and laminectomies) and have had several closed head traumas. As a result, I take Lithium, Mirtazepine, Gabapentin and Adderal-XR.
    I have needed courses of Hydrocodone/APAP five times in the last 18 months. I needed to change PCP’s five months ago and it’s been a disaster.
    This new PCP, a young (30-40) guy, residency trained (but from some caribbean school) first sent in an NP student to examine me (she did a brief neuro exam) then he came in, listened to my heart and lungs and said he was prescribing a “muscle relaxant”. I explained that my legs have been getting weaker over the preceding three months, but more importantly, the character of the pain had changed. While the pain (which I perceive as neuropathic) was still present, and perhaps a bit worse, I also felt stiffness in my legs, was having trouble getting up from a chair (or the toilet), had an episode of “facial” pain that my dentist says was not from my teeth, and had an episode four months ago of blurry vision and eye pain (unilateral) but without redness, injection or discharge. I asked for a neurology evaluation, since I felt systemically “unwell”, fatigued but not in relation to activity. I told him/them I could no longer ride my mountain bike.
    He didn’t know I was a physician, and said “look, I’m not prescribing narcotics to someone who’s taking all those psych meds and who obviously has a problem with pain medications”. “Use the muscle relaxants and then we’ll see”. The nurse came in and asked me for a urine specimen. I said I doubted that I had a UTI, but that I had been experiencing “dribbling” and difficulty fully emptying my bladder. She said “oh no, it’s not for a UA, you’re an addict and it’s for a drug screen!”. I was speechless.
    The same went on in two subsequent visits, all the time, the symptoms were progressing. Never more than a 10 minute “encounter”.
    Finally I paid out of pocket (I have an HMO) to see a neurologist, and she ordered an MRI, and it turns out I have Multiple Sclerosis. After a whopping course of steroids, the symptoms are abating, and now am on Copaxone.

    Reply
    • Oh. My. God. I am SO so sorry that this happened to you. You have every right to sue those negligent bastards, and I really wish you would because this was malpractice if I have ever heard it. I don’t know how you kept your mouth shut, not telling them your background. I usually spit mine out after the first few incompetent statements, which seem to happen more and more as the quality of medical training declines in this country.

      As you described your symptoms, my brain screamed MS! MS! even though I am “just” a wounded Pedi-ED doctor. How could they just let their assumptions that you were a “drug seeker” close their ears? My heart aches for you, being thrown in the trash bin because of these idiots’ stigma, when all the while you are seriously ill.

      I’ve been having neuro symptoms myself for the past few months (foot drop, falling, neuropathic pain in both legs and feet) but have been putting off going to my PCP because he barely even looks at me, just stares at the damn computer screen. But I am going to demand a referral to a neurologist, if it doesn’t occur to him naturally.

      Two months ago I caught my toe (foot-drop) and fell, taking a single point landing on the chin, knocking myself cold. It’s the third closed head injury with LOC I’ve had in two years. Think someone might catch on to that? Oh no, it’s the meds.

      Last week I went to see the ortho doc about the torn something-or-other in my shoulder that resulted from the fall ten weeks ago and is still painful, and I DID NOT mention my psych diagnoses nor did I list my meds. I am putting this on a need-to-know basis, and he “don’t need to know.” He agreed that there is something damaged in there and wanted to inject it, which I declined in favor of an MRI (“first diagnose; then treat” is my motto). Then he offered me Lortab and I asked for Tramadol instead. He raised his eyebrows and said “Tramadol is not as strong as Lortab,” and I told him that the stronger narcotics make me itch (they do). I did not tell him I have been falling right and left. I will save that for the neurologist.

      I want to get one or two other professionals together to go into med schools and speak to the 2nd years about mental health stigma. I have done similar things about other topics. When you are well enough, would you be interested in participating?

      And in the meantime, would you be interested in being an interviewee on my blog series, Breaking the Silence of Stigma? I believe your story will open a lot of eyes and help many people. Please let me know at dinaleah at hotmail dot com.

      Be well and take good care,

      Laura

      Reply
  4. dr12n12

     /  November 2, 2013

    Thank you Laura, for your kindness and understanding. Under separate “cover” I’ll touch base re: education programs/blog interview. I find the idea interesting, and have done a similar program about addictive diseases in the “professions”, for first year ICM (Intro. Clin. Med.) students with mixed outcomes.

    Re: diagnosis, and “talking doctor”, perhaps outing myself as a physician would have prompted an earlier diagnosis. My experience is that doing so puts the treating professional on the defense. During the whole MS debacle, with one of my bouts of blurry vision and eye pain, I went to an ophthalmologist’s office, and it turned out I was seeing an Optometrist (fine by me if I wanted a refraction), but he, and only him actually put some of the pieces together, He said I had optic neuritis, did a visual field exam (computerized) and an ultrasound of the optic nerve. He then proceeded to write me an Rx for prednisone (I didn’t even know they could prescribe) and asked me if I needed pain meds (I declined).
    I didn’t tell him that I had the same issues two years ago, and one 7 months prior. He turned out to be the brightest bulb on the string! When I have “talked doctor” in the ED,
    usually because I’m not OK with some barely pubescent resident physician ordering $10,000 in testing, when it would be prudent to first JUST check my lithium level (I’ve probably been sneaking in some ibuprofen which also has renal metabolism and I’m likely a smidge high, and my PCP is closed). Boy oh boy does that change things! All of a sudden appears an attending physician, and I’m invited into the diagnostic process…..which, is
    actually not what I desire. As has been stated before:” A doctor who treats himself has a fool for a patient….and a doctor.”. I no longer “slip” in letting it out, but use it for self protection as needed. Actually, save for rarely, psychiatrists do a better job listening and synthesizing than PCP’s in my experience.

    More will be revealed!

    R

    Reply
    • It’s a tricky business, isn’t it? Some of the times that I’ve disclosed my professional status I’ve ended up getting worse care than if I hadn’t. A friend of mine had a retinal melanoma diagnosed at a routine refraction by an optician. The optician has Tourette’s–terrifying because he has upper body tics–but they magically disappear as soon as he gets near your eyes! He’s now retired and I miss him terribly.

      Looking forward.

      Reply

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