What's up with my GP's bedside manner?

January 8, 2009 6:37 PM

I'm confused by my GP's bedside manner. I went to see Dr. B today about my sciatic pain after my physio recommended it. She assessed me and referred me for an xray, which is fine. After that, when I asked about relieving the pain of muscle spasms in my leg, she said "I have something that would work perfectly..." and "I'd be happy to give you a note so you can stay home from work..." She seemed to be either thinking aloud, or waiting for me to respond. In the end I walked away with neither. What's going on?

I generally rely on my doctor to prescribe what's best for me, not to look to me for direction. I wasn't sure how to reply to her questions, without looking like a malingerer or a drug seeker. When I tried to suggest that I was pretty miserable, she said something like, "Well, of course this is a horrible thing to go through..." What is she expecting me to say here, beyond explaining how bad my pain is? Do doctors restrict the prescription of muscle relaxants to people who break down in tears in their offices? What am I missing?

posted by anonymous to health & fitness (23 comments total)

you really have to ask her. i mean, how are we to know? is this how she usually acts? do you have a problem with her manner?

when she said she had something that would work, did she tell you what it was and give it to you? or did she leave it open for you to ask for it? if the later, that's kinda weird, but not outside the realm of possibility.

as for the note for work, yes, that's a question that she needed you to answer. did you answer it?

prescription muscle relaxers are almost as easy to get as m&ms. did you ask her for a script?
posted by misanthropicsarah at 6:46 PM on January 8 [3 favorites has favorites]

As someone who has pretty much had to refuse to leave the office and say to my doctor "no seriously, I've been drinking to get to sleep lately because my tinnitus is making me stressed out and I don't want to do that anymore, let's talk about my options" I think some doctors think that they have a read on you, that if you're not specifically asking then either it's not that painful or not that important. I think just like with non-doctors there are more active and more passive doctors.

I'm not totally sure after your GP said "I have something that would work perfectly" what you did next or why you didn't respond. It seems to me that that conversations goes something like

"I have something that would work perfectly..."
"Oh good because I've been in a lot of pain and it's affecting my ability to go to work and other things"
"I'd be happy to give you a note so you can stay home from work..."
"Well what I'd really like is some pain medication that enables me to GO to work since I have a lot of stuff I'm working on. What's the next step?"

If you have an infection then clearly antibiotics are the best course of action. If you have pain, there are many ways to manage and treat pain, depending on what sort of impact the pain is having on you which may have been why your GP was looking to you for direction. Some people like to tough that sort of thing out, some don't. Also, your doctor may have just been weird.

Where I'm from, if you're in pain due to some sort of observable problem, no one worries if you're a drug seeker. Then again if my doctor weren't prescribing me pain medication and I was in a lot of pain, I'd hang out and ask the doctor "what am I missing, why don't I have a prescription for something, what is your plan for me to help me manage this pain...?" before I left.
posted by jessamyn at 6:52 PM on January 8

Don't be stoic, they'll assume it's a minor problem.
posted by sammyo at 7:11 PM on January 8

follow-up from the OP

I could have been a bit more clear in my question (which now that I think of it could be my problem in the Doctor's office as well). I responded positively to her suggestion of muscle relaxants ("Okay, that sounds good") but then she said that she was worried that the drugs would make me "dopey" and seemed to dismiss the idea. When she suggested staying home from work I was confused about whether she meant I should stay off my feet for the sake of my back, or whether it was simply a comfort issue. I really was trying to let her take the lead (she could always prescribe the drugs and I could decide not to take them if I didn't like the side effects), but perhaps she was doing the same.

posted by jessamyn at 7:14 PM on January 8

I generally rely on my doctor to prescribe what's best for me, not to look to me for direction.

This doctor felt that you did not need them enough. I disagree with your statement as you obviously think you did need them or you would not be posting here. Dr's are a lot of things, but generally not mind readers.

Jessamyn's conversation model is the way it goes. Or, can I please have something for the pain and a plan for fixing whatever is causing the pain.
posted by JohnnyGunn at 7:16 PM on January 8

It honestly sounds like crossed wires. When I began to realize my pain was not normal and not going way, I had to learn an entirely new way of communicating with physicians. It was touch and go at first.

1. Reference that standard 1-10 scale of pain-- does the pain wake you up at night? Keep you from falling asleep? Dressing yourself? Working? Walking 10, 15, 60 minutes? The more precise you are the more information the doctor or PT has.

2. Keeping precise records of when pain comes and goes and the intensity will help you communicate with your doctor. It might also make you look like a pill seeking nutjob hypochondriac. But in my experience, it got my complicated case taken a lot more seriously than I think it otherwise would have.

3. A startling large number of people prefer to "tough it out" no matter how debilitating your pain. Your doctor might have interpreted your silence to mean you fall in that camp. The stigma of taking pain meds likely keeps lots of people from getting relief when they need it.

4. If you need pain medication, ask for it. Your doctor acknowledges you're in a world of hurt; she will not label you are a pill-seeker. If she does, get a referral to a specialist and seek a new GP.

5. One thing that sets off alarm bells not only of doctors but also of the DEA is going from doctor to doctor looking for medications. I understand that is not what you are intending to do. At least talk to your doctor about a script before giving up on her completely.

Call her tomorrow, explain the pain is worse or explain the pain in terms of how it has an impact on your daily life, and she will prescribe something.

Whether or not it will help is another matter, because my understanding is that sciatica doesn't respond well to muscle spasm relievers. In fact treating sciatica with muscle spasm meds indicates you need specialist input.

I am not a doctor, but I'm a long-term patient with a neurological problem whose seen more specialists at "world-class" hospitals than I have fingers on my hands. Doctors are not always decent communicators and a lot are jerks. So it is all the more important to communicate clearly what you need as a patient.

Not all doctors are jerks, however. Some appreciate precise, meticulous records, so it's a good idea to begin keeping them to document your pain.
posted by vincele at 7:26 PM on January 8

I also have a hard time figuring out why you remained silent through this...?

You: "Is there any way to relieve the pain of the muscle spasms in my leg?"
Doc: "I have something that would work perfectly..."
You: *Silence*
Doc: "I'd be happy to give you a note so you can stay home from work..."
You: *Silence*

It's little wonder to me that nothing productive took place.
posted by Precision at 7:31 PM on January 8 [2 favorites has favorites]

Based on your follow-up, it sounds like your doctor was waiting for you to make a decision. "Yes, please write me a note, Doc, I don't like the sound of those drugs and a couple days in bed might help." Or "I'd like to try the drugs if that's possible; I'm in quite a bit of pain. I'd rather be a little dopey than experiencing all this pain." Alternatively, you can ask more directly what your doctor would recommend. I've been in similar doctor-patient relationship situations before and just took it to mean that the doctor was allowing me to decide my treatment.

When you go in again, promise yourself that you won't leave without something that concretely helps you, whether that's information, drugs or a note. Before leaving the office, do a verbal recap with your doctor of the next steps ("Okay, you're suggesting trying to keep off my feet for a few days and if that doesn't help, I should call your office to get a prescription.") I've never tried this, but perhaps if you have a little notebook with you, you can jot down your course of treatment. If you don't have a solid plan written down before you're being shooed out of the office, you need to clarify the situation with your doctor.
posted by Uncle Glendinning at 7:36 PM on January 8

Ok reading your update, I'd add: get the note to stay home from work and try out the meds for a day. You're right, you don't know what the side effects could be. Best to find out in the comfort of your home.

Your body needs rest, for at least a day or two if you are suffering from back problems. No you shouldn't lie on your back for weeks, but if you are in moderate to severe pain, pushing yourself before you know what's going on with your back could have long-term, irreversible consequences.

Your doctor thinks "pushing yourself" might mean going to work for a day. Take the day off and take the meds.

And please, get hooked up with a specialist as soon as possible. (IANAD, IANAPT, YMMV, etc.)
posted by vincele at 7:42 PM on January 8

The way I interpreted the conversation was "Well, the drugs might make you somewhat 'dopey', so would you like me to write you a note so you could stay home from work? (Since the drugs would affect your performance.)"
posted by wsp at 7:55 PM on January 8

I agree with Jessamyn in that I've learned it's best to be your own advocate when it comes to doctors. You may not want to seem like you're asking for drugs or downtime from work, but the doctor sees you for what, 15 minutes? She doesn't really know your pain the way you do.

I think she was trying to appear empathetic ("of course that's terrible"), and inform you (the drugs might make you dopey, I can give you a note), but was waiting for you to make a definitive statement (rather than, "that sounds good," a better answer would be, "I think I need the muscle relaxant, and I'd like you to write me that note just in case it DOES make me dopey").

Don't be afraid to be assertive--remember that at the most basic level, you are paying your physician for performing a service for you. Think about it: if you went to a restaurant for a meal, the waiter might suggest the daily special, but it's up to you to place the order.
posted by misha at 8:45 PM on January 8

The thing I like to remember when I go to the doctor's office, is that they're being paid a decent amount of money by someone in order to make me feel better. So we talk about my check-up, and I show them the odd things my toenail is doing, and I ask weird questions that I wouldn't ask anyone else. The doctor's office is the one place where I try really hard not to be cool. Because I want as much help as I can get, and they should have the best variety of options. So don't be afraid to go into detail. Like, I use my left arm a lot to carry things, so if I could get the shot in my right arm, that would be cool. Or is my toenail going to fall off? What are my options? What if I want to go swimming, will that still work out? Really? Is there anything else I could do? Ask questions, talk about myself so that the doctor knows my opinion and situation.
posted by redsparkler at 8:49 PM on January 8 [1 favorite has favorites]

Half the time I tell my patient all about the great medicine I have to prescribe for them and then I forget to give them the prescription.

My sharper patients generally remind me.
posted by ikkyu2 at 9:35 PM on January 8

she sounds like a dolt.
posted by docpops at 9:56 PM on January 8

To clarify: Always offer to relieve pain. Let the patient reject the offer or choose not to fill the Rx. If you make the patient ask they feel/look like a drug seeker, leave feeling "weak", and will be calling back for problems in a day wasting the time of your staff and you. Or they'll post on Metafilter. Or they'll stay home the next time they feel like shit when they might have something serious. It isn't fucking rocket science. Patients have better things to do than waste their time coming to see us. If they're in your office they need some help. Floating therapeutic balloons to see what the patient grabs onto is a medical model for either morons or a physician in some sort of absence reverie. In either case, consider it a potential sign of further problems. Good luck.
posted by docpops at 10:04 PM on January 8

Some doctors are into managing a patients health, being aware that some people don't like pain medication (and some really, really do), some people want to take time off work, others don't, some people are into vitamins and dietary supplements, others want the hard stuff...they want the patient to give them clues as to which way they should treat them.

Others doctors just want to hand you a scripts and get you out the door so they can get started on the next patient.

Some patients want doctors who take an individual interest in them, who they can discuss treatments with, find the best solutions for their health problems.

Some patients want doctors who will just hand them a script and let them get on with the day.

Some of these doctor/patient combinations are, as you have discovered, a bit incompatible.
posted by Jimbob at 11:20 PM on January 8 [1 favorite has favorites]

This is something I've been noticing more and more from doctors lately. Certainly, it's good for a doctor to listen to his patient's needs. But sometimes it seems like they think you have a secret agenda they're going to have to please, no matter if they do what's best for you. I've had these exact kind of moments: the doctor will make some suggestions, but with a little interrogative uplift at the end of them, then they stand there waiting for me to say something, while I'm waiting for them say which suggestion is the best one. And why am I waiting for them to say? -Because they're a doctor, and I'm not! It can be exasperating, not only for the communication glitch but also for the implied... distrust, or whatever it is.
posted by Rich Smorgasbord at 11:22 PM on January 8

Are you sure you didn't get a paperless prescription? My doctor doesn't hand me an actual prescription, it just gets faxed to my preferred pharmacy and all I have to do is pick it up. Of course, if you don't have a pharmacy on file, this won't apply to you.
posted by sageleaf at 11:47 PM on January 8

I'm pretty sure this is something that the NHS has just - as in, within the last five years - started telling GPs to do (if you're in England, as I suspect you are). There's some sort of dialectical process going on. Basically, in the early heady days of widespread internet access, GPs reacted shirtily to patients arriving with reams of information about their own conditions. But because there were also beginning to be strong cultural currents in the direction of celebrating choice as thing to aim for in public services, because of a general loss of faith in traditional sources of authority, and also because of the unforeseen success of the 'support group' model, those in decision-making positions decided that informed, empowered patients were A Good Thing. This led to good stuff like doctors directing patients towards resources like patient.co.uk for further information, and a bunch of ham-handed stuff as well. I reckon the tide is due to turn soon, as doctors - and those in charge of doctors - realise that patients really hate being offered these sorts of 'choice', and also with the success of 'Nudge' and other calls for a return to greater institutional paternalism.

I was in a similar situation to you when I went to see a doctor about tiredness which a friend of mine thought was problematic. I wasn't even sure it was a problem; I wanted the doctor to assess all that for me. The doctor took the approach that since I was there, it was clearly subjectively a problem, and also repeatedly asked me (after blood tests etc. came back normal) what I thought might be wrong with me. "I don't know - I'm not a doctor" didn't seem to be an acceptable response. I suspect, though I have no confirmation of this, that if one sounds educated, middle-class and tech-savvy one is more likely to run up against this attitude of 'clearly you will prefer it if I let you be your own doctor'.
posted by Acheman at 12:18 AM on January 9

I've had similar experiences to Acheman (also as an NHS patient in the UK). I think there's been a slight overcorrection in the direction of treating the patient, not the symptoms. The youngish GP I last visited seemed to leave pain medication as something of an open question until I clearly stated that yes, I would like some, because it really hurts sometimes. And I had to remind her at the end of the consultation to print up the prescription. I don't know whether that was a case of over-worked absent-mindedness or a tactic to ensure that I really did want the medication.

In contrast, the GP I normally see (who looks like Terry-Thomas and smokes like a chimney) is much happier to take the "I'm a doctor here, but I'm not going to be an ass about it" approach, and will happily tell you exactly what he thinks you should do.

Given the choice, I really prefer the latter. He's the doctor who arranged an appointment out of the blue, then said "Look, you've been on antidepressants for two years now. Unless you're still feeling sorry for yourself, I want to get you off them." And he was completely right; I needed telling. The other type of doctor would just have listened patiently to me, sympathised and renewed the course of medication.
posted by le morte de bea arthur at 3:32 AM on January 9

i'm back in this thread to say to everyone: you MUST advocate for yourself at the doctor. if you are shy/wimpy/etc. bring someone with you to advocate for you. it's common to get flustered at the doctor and just let them walk all over you and then you forget to tell them some really important thing. if a friend/spouse is there, they can speak up on your behalf and help you get the treatment you need.

the insurance companies do not care about you, and i find that fewer and fewer doctors care about you (in the human sense). so since no one else cares, you must care for and about yourself and speak up if you are not getting the treatment you need to feel better.

just sitting there while the doctor rattles off a list of options is not helpful. ask questions. ask followup questions. if you didn't really understand something, rephrase it in a way that says what you think it meant, and ask the doctor if that's what was meant. if they give you a script, ask if you should take it at night or in the morning or if it will react with the other meds you're taking. yes, they have a list of your scripts in your file, but they don't always look at it.

i am not anti-doctor. i have several good ones. but you are being severely remiss if you do not take your healthcare into your own hands to the extent that you can.
posted by misanthropicsarah at 7:57 AM on January 9

It's a conversation, not a dictatorship. If your doctor offers to give you an excuse to get out of work, take it (unless you just love being at work). If she offers you medicine for the pain, take it if you want it. She's giving you a choice. If she forgets, remind her. By being passive and spineless about it, you're cheating yourself out of your care (not to mention a day off work!!).
posted by mynameismandab at 10:05 PM on January 9

I live in a small town in the South that has to have more pill heads per capita than anywhere else. It is so bad here that currently there is only one GP that will provide pain meds for any reason. The rest want to refer you to a specialized pain clinic which would be great if I had any kind of insurance.

I was in a really bad motorcycle accident that has left me unable to walk and with pretty severe chronic pain. While I am not addicted to pain meds I am dependent on them. When I first started seeing my GP I had to go thru all the usual x-rays even though my scaring is significant and pretty much tells the story itself. Even after the x-rays I had to point blank tell him that I need something for the pain. It took us a couple of visits be we finally came up with a combo that works for me and doesn't knock me out.

In this day and age of addiction and prescription medication abuse you have to be very vocal with your doctor. They are so used to hearing about someone's pain when there isn't a thing wrong with them that they have forgotten how to listen to ones with a real problem. If you are still hurting, call your doc. When you get in there tell her in no uncertain terms that you need some relief and explain in precise detail what is going on and where it hurts. And don't leave until you feel that your problems have been addressed.
posted by Jules22871 at 11:35 PM on January 9