An Anorexic’s Nightmare

I’ve been out of touch.

Quite literally.

My waking hours are wasted spent “running to doctors,” as my grandmother of blessed memory would have put it.

So many doctors, so little time.

And the striking thing, the thing that literally renders me speechless, is that none of them ever touch me.

Not even with gloves on.

They “listen” to my heart and lungs through the three layers of clothes on my torso: camisole, tee, and blouse. 

I’ll let you in on a trade secret: the stethoscope has to go on bare skin.  Otherwise all you hear are three layers of cloth moving against each other: scritch, scritch, scritch.

They don’t look into my eyes, nose, or mouth, although volumes are written there.

Nor do they palpate my abdomen, which, if they did, would give them a surprise, since I have a couple of tender masses in there.  In fact, my erstwhile gastroenterologist, who had it firmly in her mind that I had IBS before she examined me, mashed into my belly like a jackhammer, and while she watched me peel myself off the ceiling, she mumbled, “Hmmmm.”  Yet she did not question her diagnosis.  I fired her.

I got a shock the other day when I requested a copy of my latest MRI from a specialist who had only touched the affected part of my body one single time, out of the several times I’ve seen him.  On that first visit he did pretend to listen to my heart and lungs.  I had a sweater on that day in addition to the above mentioned layers, so his exam was extra special.

When I picked up my MRI report, the receptionist handed me a copy of the clinic notes from my most recent visit.

It said:

“Well developed, well nourished white female in no acute distress. 
Pupils symmetrically reactive.  Cranial nerves grossly intact.  Trachea midline without deviation.  No jugular venous distension.  Heart: S1, S2 normal, no friction rub or gallop.  Lungs clear to auscultation and percussion without wheeze or rales.  Abdomen soft, non-tender, no masses…..”

In short, whether or not you know the jargon, here is an entire “normal physical exam,” none of which was ever done. 

This is the gift of EMR, Electronic Medical Records.  It provides a default “normal” physical exam, altered only if the provider inputs other findings.  One would think that this amounts to falsifying medical records, wouldn’t one?

When I was a medical student, we (or at least I; I can’t speak for the other students) practiced this catechism of normal findings, writing it longhand over and over until I had it memorized in my sleep.  That way we knew what was normal and what was not.

There were two differences, though: in my day we actually wrote things in paper charts.  We had to write really fast, so our notes looked like this:

“WDWNWF in NAD C/O SOB x4H”

Translation:

“Well developed, well nourished white female in no acute distress complains of shortness of breath for the past four hours.”

The other difference is that we actually laid hands on the patient.  We had them undress and put on a gown so we could lay the stethoscope on their chest and close our eyes and listen for those subtleties and nuances of the music the heart makes.  I remember silently cursing chest hair: scritch, scritch, scritch….

And if we didn’t examine something, we wrote: NE (not examined).  But we were not allowed to not examine something, unless the patient objected, in which case we wrote:  PUC (Patient Uncooperative)!

Although we are no longer allowed to describe physical findings in strings of acronyms (although we are apparently allowed to falsify that we actually examined the patient), there is one acronym I will never let go of, especially now that I am getting some practice being a patient.  It is:

WNL

Which is supposed to stand for

“Within Normal Limits”

When I was a student we had an inside joke that WNL actually stood for

“We Never Looked”

Only nowadays, it’s no joke.

Oh yes.  The Anorexic’s Nightmare.

I lost two inches because my spine in collapsing.  Therefore, my BMI is now 25!!!!   I’m suddenly overweight! 

How did this happen?

It’s not fair!  It was that rice I ate yesterday.  That must have been it.  Oh, wait!  I ate a cookie!  Gaaaaaa!  And I’m not bulimic, so I can’t do a thing about it! 

Gaaaaaa!!!

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30 Comments

  1. sadly, my records are the same. I once had an attending doctor, who barely spoke to me, let alone exam me, write what you have written in this blog. It’s totally falsification of the record.

    Reply
  2. Though I do not understand this medical jargon, I am surprised by the attitude of medical professionals. One does not expect such thing to happen in USA.

    Hope you are better than before and are on a road to recovery.

    God bless

    Reply
    • I myself am clearly shocked at this state of moral and ethical corruption. Medicine used to be a calling, not a business that cheats on its records. Shameful.

      Thank you for your blessing, Ashu. I am this moment absorbing your gift of good vibrations! I am seriously thinking of chucking all this and going to live with my guru. Really, at least I would live in a harmonious atmosphere, and have massages, and lovely food. If I’m going to be in pain, it may as well be in beautiful surroundings, with people I love and who love me in return.

      How are you doing, dear?

      Reply
      • I am well. Thanks for asking.

        Professionally and personally I was in a fix as I had to take a big and risky decision. Then I decided, who am i to take let my Guru take me wherever he wants. He knows what is the best for me.

        I hope you get the same divine inspiration to make any major decision in your life.

        Love and light
        Ashu

        Reply
        • Thank you, Ashu. Did your decision work out well for you?

          It is such a gift to recognize when we are being led by the Divine. And of course, that is all the time, but I for one have a tendency to forget that!

          Reply
  3. Laura,
    I have noticed the same things you have just written. In the last five to ten years it seems to have gotten severely worse. I grow more concerned each time I have to visit a doctor, if I see an MD at all. I may notice more than some because I see several types of physicians and also fire them. Ha!
    I am truly sorry you are going through this. I always have you in my thoughts. Sending you love, always. Special thoughts tonight.
    xxx, CC

    Reply
    • Dearest CC, I treasure your thoughts! I’m sorry that you’re on the “doctor train.” In a word, it sucks! Yup, if they’re jerks, we fire ’em! I pay a bit more for my insurance so that I’m not stuck with “in-network” providers. Bad enough, there’s a system here where all the doctors have access to everyone’s records, so that their opinions are already poisoned when they see you. It’s impossible to get a fresh opinion. I totally opted out of this system when I saw my first primary care person here (a very sweet nurse practitioner who is totally overwhelmed by my “problem list.”), but apparently it happens automatically. I feel totally out of control.
      ((Hugs)) Laura

      Reply
  4. Hi Laura. This is just a travesty. It makes me so angry to see an individual treated this way … all my huggs

    Reply
    • Hi Daisy, it makes me angry too, that my profession has become so degraded. I desperately miss my family doc in Israel. The first thing he always said was, “How can I help you today?” Which was almost exactly what I used to say when I was in practice. Then, when we were finished with whatever I initially came for, he would say, “What else can I help you with?” And that was good, because there was always something I’d forgotten, like med refill or something like that. Good docs are hard to find 😞

      Reply
  5. Although this shocks me, it doesn’t surprise me. I clearly think the ‘canned answer’ is fraud! I’ve been to many doctors that have poopooed my research into my thoughts on my health. No. I am not a Dr, however I know how to research things and go to reputable websites and sort through the gobbly-gook.
    My PA is great. She may not be a full blown Dr, but she listens (and touches me!) to me and even let’s me try the drugs I want to try (within reason).
    I recently started seeing a shrink. He put me on Lexapro. I like it so far. However, I think he thinks his job is done. I got the same RX out of my gyno for perimenopause… I’m going to the shrink to sort my issues so I don’t need to be on drugs. At least that’s what I thought these shrinks do. I asked him if he could help me with my fear of changing jobs, as I used to change careers at my fancy. He said I’m just getting old and have less acceptance to change. This is what I hate about shrinks, I am not the same as others, don’t lump me in a group! I think I’m going to lose this guy, keep my gyno RX and spend my money on a life coach. πŸ˜ƒ
    I hope you can sort through your health issues and feel better. Get a new Dr, hopefully that will help. I’m sending big hugs to you and although I’m not physically touching you, I bet you feel them more than your doctor’s touch πŸ˜‰πŸ˜‰
    Kiss Atina for me!

    Reply
    • Hah! I pity any stuffed shirt M.D. who tries to bully Ms. Ilex! Oh man, I’d like to be a fly on the wall.

      I’ve been very fortunate with shrinks, although I’ve fired quite a few. My last one was a treasure. Of course he had to get sick and retire on me, just so I would know how my patients felt when I retired.

      Let me know how you do with the life coach! I’ve never had one, but I’ve known a few. Try to get one who isn’t doing it because they can’t get a job and just need money.

      I will kiss Atina for you, but I have to be careful to avoid her tongue, because her anal glands need expressing and she’s licking her ass all the time…aside from being gross in general, she stinks of rotten anchovies! I could express them myself, but I’d have to muzzle her and tie her up (Malligators are particular about their persons). So we will visit the vet on Monday and let them wrestle with her.

      You’re changing jobs? After getting rid of Pink Hair πŸ˜…πŸ˜„?

      Reply
      • Ha ha! Rotten anchovies! Never heard it called that before, but sure is on the money. 😱
        I hear ya on the life coach thing. I will do my research. Thanks for the tip.
        Eh, I like to be able to change jobs if I want to. Not so much that I need to right now.

        Reply
  6. This just pisses me off! Why didn’t they write after the “well developed, well nourished white female in no acute distress”…..advised patient that running a full marathon was well within the parameters of acceptance….
    Unbelievable.

    Reply
    • WNL, you know….

      My chief complaint at the cardio was shortness of breath in the context of blood clots in my legs. That is a trigger for pulmonary embolism, a blood clot that travels from a distant location to the lungs. But never mind that, the PA referred me for varicose veins, so my concern is of no concern. If I die of this, I’ll sue the fucker,!

      Reply
  7. Ugh…doctors. You know how I feel about most of them. Finding a good one is like questing for the holy grail. In my experience, the residents tend to be more thorough because they’re trying to learn.

    BMI is a crock of shit. People can be obese with a normal BMI, and lean with and high BMI. Weight:height doesn’t have anything to do with body composition. I read something about a suggested (by insurance companies) move to waist/hip ratio as an indicator of body mass, over BMI. Probably so they can jack up prices and deny more people. Of course, that’s not entirely foolproof either. Some of us are shaped like a sad tree trunk.

    So, I encourage cookies. Cookies don’t judge. πŸ˜€

    Reply
    • I agree, teaching hospitals are much better, usually. It can get annoying when you’re really sick to have to tell your story ten times over, but at least, as you say, they tend to be interested, especially in a “case” like yours. I hope they’re treating you like a person, not simply an interesting and complicated “case.”

      That was one thing that always maddened me about the grownup doctors. Pediatricians tend to be more empathetic, because, you know, kids. But it seems like you’ve got good attendings, even though the house staff change with the moon…?
      Love you xxx

      Reply
  8. I get the same thing all the time
    It has taken me practically a month
    To be diagnosed for a herniated disk
    And to make matters worst I did get pain meds for awhile
    But no more
    The Dr doesn’t believe in them
    So now I still have to wait
    For a shot on the 27th
    They have to put me out
    God I hate these fuvkers
    Same with the gastroenterologist
    I still can’t get a call back to set up testing on my stomach
    Oh sweet Laura
    I’m sending lite, love, and prayers
    Didn’t mean to rant
    As always
    Sheldon

    Reply
  9. Well of the all the doctors are who are a piece of work, err shit, I say move on until you find a decent one. Have you thought about reporting these f—kers to state board? Would that help anything?

    My daughter has encountered countless MDs in Austin,Tx that do not give a fig about the patient. After 3-4 years of searching she now has three good ones but the meds she should be able to take give her terrible side effects so she shoulders on now with a pain management MD. I have asked her to write a book but she said she can not bare to revisit all the nightmares that she encountered trying to get diagnosed.

    I admire your grit and able to see a wee bit of humor in your life. I pray to God that you will find a compassionate MD who will take a “vested” interest in you. I so hope you are feeling some better, some how, some way.

    Sending good karma to you and Atina.

    Reply
    • Ugh, I’m so sorry for your daughter. What a mess. I’m glad she’s found docs she can trust.

      This electronic medical records BS was actually mandated by the federal government. I think the idea is to eventually have all medical records shared, which will be a disaster because it will be impossible to go to a new doctor to get a fresh opinion, because they will read what the previous quack said and have their brain already poisoned.

      But that is unlikely to happen anytime soon, because every practice buys a different system and they aren’t compatible. But there’s no way to really sue them short of a class action suit, which is what I think would be necessary for any change to happen. But who to sue???

      Thank you for the dose of good karma! Right back atcha 🌷🐦🍦🌞🐝❀

      Reply
  10. If only you could do something like sue them for not doing their jobs properly. All this bloody paperwork is only making things more difficult for both doctors and patients.

    Reply
  11. Interesting that many physicians do not palpate, for they should. Listening to one’s heart through a sweater? Ridiculous.

    Reply
    • Gone is the art of medicine.

      Reply
      • MD’s are forced to cram patients in, not allowing enough time for proper exams.

        Reply
        • I don’t think that’s the case.

          For a new patient, they’re allowed 20 minutes at least. Plenty of time to review the history form (my cardiology history form did not include family history!!!!), say hello to the patient, ask about any positives in the history, and do a thorough physical exam.

          I can do a thorough physical exam in 6 minutes, including eyes, ears, mouth, throat, and all major lymphatics, heart, lungs, abdomen, neuro, extremities, and skin. I do my review of systems during the physical, so that both the patient and I have “haptic feedback.” It’s really not that hard. This works well, because when the patient comes in for subsequent problem-focused visits, I’ve already “gotten to know them.” If I don’t know what their baseline is, every visit is like an urgent visit. No prior knowledge.

          Reply

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