help processing bad dr. office experience

February 8, 2012 11:50 AM

Please help me process this traumatic doctor's office experience. Will saying anything to the doctor help?

Yesterday I went to the pulmonologist to investigate some breathing problems -- possible asthma. I am pregnant so obviously it's of great concern to me that I remain breathing! The technician had me do a lung function test for asthma, with results recorded by computer (breathe in, breathe out all the air in your lungs, then forcefully breathe in again, repeat several times.) I immediately started having serious difficulty with the breathe-in part, culminating in a GIANT TERRIFYING LARYNGOSPASM that left me sobbing, literally unable to breath, and then choking and gasping loudly for what seemed like at least 2-3 minutes. So we stopped the test. When a different technician tried to get me to continue with the test later on, the same thing seemed like it was going to happen again, and so I asked her if there was any point to making me go through that again! She annoyedly said "no, we have what we need" and made some comment about me being "hormonal."

So then I go in to see the doctor, who casually looked down at a printout of my test, and said "Well you don't have asthma, take some antibiotics, you'll be fine." Apparently, the technician had not told him anything about what had happened; he hadn't bothered to consult her. I told him, "but I could not breathe AT ALL, go talk to the technician." He talked to her, and I heard her confirm that I couldn't breathe at all. The doctor still seemed totally unconcerned and said, "Oh, guess you had a laryngospasm, you have a history of that." (Which I do, but never as seriously as this, and never induced by my DOCTOR!)

And so that was that. I feel really upset and not sure what to do about it. Upset at what happened, first of all, which was terrifying. Upset that the doctor didn't bother to talk to the technician before "diagnosing" me. Upset that he was looking at printouts of my lung function test which I don't think could have been accurate, given that I had to stop the test before finishing due to NOT BEING ABLE TO BREATHE. And finally, very upset at the perception that I was just a hormonal pregnant lady exaggerating what was going on.

Phew. Thanks for reading. My question is -- I have a followup appt on Friday. Is there any point in laying this all out to my doctor?

posted by anonymous to health & fitness (14 answers total)

Get a second opinion from another doctor.
posted by empath at 11:53 AM on February 8 [11 favorites]

Do you have a doctor you trust - a GP, or your OB/GYN, or someone? To me, that is the most important part of picking a primary care physician, is someone I trust.

I've had the same issue before, where I go to a specialist and get questionable results back. I take those back to my GP and discuss with him. If he agrees it was questionable, he can send you to another specialist, or run new tests himself. So go back to another doctor and discuss the situation and see if they agree.

Who is the Friday follow up with, the pulmonologist or your regular doctor?
posted by I am the Walrus at 11:55 AM on February 8 [3 favorites]

The tech was insensitive. The doctor didn't take your concerns seriously. Those are absolutely reasonable things to be upset about.

That said, I have had exactly the same experience with those lung function tests; I'm sorry you had to go through that! I think the design of those devices is suboptimal for use with people who are currently experiencing breathing problems.

I would bring that up in a measured way on Friday and describe what you didn't like about the experience. Maybe jotting down bullet points on an index card would help. Ask him if there are other possible tests for asthma with devices that wouldn't be so likely to trigger a laryngospasm.

Often people who aren't used to dealing with patients in crisis lose their bedside manner skills. (And I'm not sure pulmotechs even ever get any training in same.) Feedback about that is certainly helpful, but I'm not sure how much change is possible. What is possible is for you to talk about what is and isn't a good fit for you as a patient.
posted by Sidhedevil at 12:00 PM on February 8

Do you have restrictive insurance that keeps you from going to another doctor? Because it's totally fine to switch to someone who has a better bedside manner. If your insurance situation is restrictive, you may still be able to switch to a different doctor in the same practice, if there is one.

Also, you might find it helpful to bring someone with you to your next appointment. Your significant other, a close friend, a sibling, etc. Someone who may be able to remain calm and make sure that everything you need to communicate gets through to the doc. (I'm not saying you're not calm - but you're going through an ultra-stressful situation and it can be hard to communicate everything we want to a doc even without that stress.)
posted by BlahLaLa at 12:04 PM on February 8 [1 favorite]

"I am pregnant so obviously it's of great concern to me that I remain breathing!"

Well, yes, I think most everyone, pregnant or not, would like to remain breathing. :)

I just went through my yearly bout with bronchitis, so I know how scary and awful it is when you can't breathe for minutes on end - the tech and the physician were terribly dismissive of your episode. You may be hormonal, I don't know, but it doesn't matter. It's something that they should have been more attentive to.

I'd do what the other commenters said - talk to another GP that you trust, or get a 2nd opinion and lay out your past experience and concerns upfront.
posted by HopperFan at 12:05 PM on February 8 [3 favorites]

I would write a letter saying what you say above, and saying that you did not feel respected ("hormonal") and that you were not comfortable with the diagnostic technique either (doc didn't know you hadn't finished the test -- doesn't instill confidence). I'd say I hoped that they would work harder on these matters ("bedside" communication and "tech-to-doc" communication) and that in the meantime I was taking my business to doctor X, and could they please forward my file to her office at XYZ.
posted by feets at 12:14 PM on February 8 [10 favorites]

I don't know if this helps at all but I definitely had (benign) shortness of breath and all sorts of weird respiratory stuff going on when I was pregnant and yes, hormones do play a part in that for some women. It sounds like your doctor and/or the technician wasn't super sensitive and that you have a legitimate complaint, but I just thought I'd try to allay your fears a bit on the causes.
posted by otherwordlyglow at 12:20 PM on February 8

Unless I wanted to stay with Doctor One. In which case I would totally bring it up on Friday, a la

"As you know, I had a giant laryngospasm on Tuesday during the exam, and I was pretty bothered by the aftermath. It was the biggest, most distressing one I'd ever had, and when I cried, the tech didn't offer to stop the test, and went on to comment that I was 'hormonal'. I didn't feel respected, and I wanted to let you know that."

Doc says blah blah blah. Then you say

"Thanks for hearing my concern (or not, if he is unresponsive). I had one more concern after Tuesday, which is that I didn't understand how the printout you were reading could be valid seeing I hadn't finished the test, and I was startled that I was seeing you without you having first discussed my test with the tech. Can you tell me how that works?"
posted by feets at 12:23 PM on February 8 [8 favorites]

Your feelings are totally valid. But I have a feeling that neither a face to face nor a letter will carry the force of a communication from your referring doctor. If you have GP who sent you to this doc, I'd sit down with your GP as I Am the Walrus suggests. If some other doctor like your OB GYN referred you, then sit down with that doc.

If you are self-referred to this pulmunologist, I would definitely get another doctor pronto, and explain the unpleasant and insensitive treatment you got at the first pulmunologist up front so they appreciate your concerns.

Very sorry you experienced this. Some doctors really lack a human touch, and needless to say they don't tend to attract the most sensitive and caring staff, either.
posted by bearwife at 12:24 PM on February 8 [1 favorite]

Assuming you were referred by your GP or OB, I would go to them (and not bother with a follow up with shitty doctor, why should they get any more money from you or your insurance?) and explain what happened, and why you were uncomfortable with their behavior. Your trusted doctor can give you a different referral, and perhaps won't refer the crappy pulmonologist to other patients in future. This prevents the crappy doctor getting more business, and also saves future patients from dealing with his crappy attitude and crappy techs.

If you self-referred, then feel free to leave a bad review on yelp or any other sites that allow you to review doctors.

As a secondary comment, THANK YOU so much for teaching me the word laryngospasm. I get these occasionally, and got them almost every night while I was pregnant (I am also asthmatic). They are absolutely terrifying, I never knew that there was a specific medical term for them, and I am relieved and reassured to know that I am not alone, or a crazy person. It makes me feel significantly empowered to be able to read up and understand more about them.
posted by Joh at 12:48 PM on February 8

I have a lot of friends who are in medicine. I think that one of the problems they all have is that they tend to evaluate patient experience in an on/off sort of way. The main question in their minds is generally "Did she die?" if the answer is "no" then most concerns are brushed off with "Then what's she complaining about?"

I'm absolutely not saying that this is the right way to approach things. I think it's abysmal and I think it's why there's something called "bedside manner" and it's something patients spend a lot of time talking about and reviewing doctors about/for. It really sucks because while it's funny and adaptive and pragmatic for the health professionals to adopt this kind of attitude, it really does destroy compassion and bedside manner.

I think that if I were to have such an experience with a healthcare professional and I meant to address is directly with that professional, I would address it from a "bedside manner" perspective. You can then bring in your personal experience and work it from that angle.

But I also agree that I would probably take it to the referring doctor and review sites and address it there as well. If my experience were really bad, I would probably also take it to the Board.
posted by kalessin at 1:04 PM on February 8 [2 favorites]

Yes, absolutely lay all of this out with your doctor at the follow-up. You deserve good care and you didn't get it. State everything as factually as possible and try to give an objective summary, but certainly it's very useful for your GP to have this information in deciding whether to recommend this pulmonologist to patients in the future.

(Also, if you need to see a pulmonologist again, you should absolutely ask to see someone else!)
posted by sonika at 3:08 PM on February 8

Was it done in a hospital? They'll have a patient complaint department, and at least here they're required by law to respond within X days (My mom works at one). I'd also get a second opinion, but just wanted to let you know this is one avenue of redress.

My sympathies; I just had a breathing test done and it nearly induced a panic attack.
posted by desjardins at 12:58 PM on February 9

Your doctor's and the tech's behavior was unwarranted and dismissive, and I would either find a new doctor or talk to them about wtf they were thinking.

However, the laryngospasm itself might just always happen to you on the computer peak-flow test things, even if your tech is the most saintly person in the universe (did you have the birthday cake graphic, and they told you to strive to blow out all the candles, btw?). It happens to me, though less severely than you, every single time I do that test, and has for probably ten or fifteen years. As far as I've been able to figure, it's something about expelling that last little bit of tidal breath that sends my asthmatic lungs into an absolute panic.
posted by badgermushroomSNAKE at 1:19 PM on February 9