How do I gently talk to my family doctor about her mistake?
June 20, 2019 3:24 PM Subscribe
My wonderful family doctor failed to realize that I'm going through early menopause.
When I saw my family doctor for concerning symptoms months ago, I was shaking with anxiety. She prescribed an SSRI and suggested therapy. Yet, the explanation that anxiety alone caused my symptoms didn't ring true for me.
Last month, I visited a doctor out of my health system who has a good reputation as a menopause specialist, and she confirmed what I had suspected -- that I am going into early menopause. Testing confirmed that I was very low in all sex hormones and, according to her, 'running on fumes.' She prescribed estrogen and progesterone to replace what I need.
I feel amazing on the hormonal therapy and am grateful for this treatment. It made a positive difference right away.
When I return to my family doctor for a checkup, I will need to explain my treatment and diagnosis. I will also have to ask for specific ongoing monitoring thanks to the HRT.
How do I move forward smoothly and gracefully with my family doctor? Upon my return, it will be clear that she made a mistake in treating only my anxiety (which was due to symptoms), instead of treating the symptoms that led to anxiety. Yet, I believe that all doctors make mistakes and that she will learn from this. My menopause is premature (early 40's), and so I believe that was a factor in her being unable to see the diagnosis.
I guess I am looking for specific phrases or terms to say. I think it's possible that seeing me so normal and happy on this treatment will help her to see the validity of this new diagnosis.
When I saw my family doctor for concerning symptoms months ago, I was shaking with anxiety. She prescribed an SSRI and suggested therapy. Yet, the explanation that anxiety alone caused my symptoms didn't ring true for me.
Last month, I visited a doctor out of my health system who has a good reputation as a menopause specialist, and she confirmed what I had suspected -- that I am going into early menopause. Testing confirmed that I was very low in all sex hormones and, according to her, 'running on fumes.' She prescribed estrogen and progesterone to replace what I need.
I feel amazing on the hormonal therapy and am grateful for this treatment. It made a positive difference right away.
When I return to my family doctor for a checkup, I will need to explain my treatment and diagnosis. I will also have to ask for specific ongoing monitoring thanks to the HRT.
How do I move forward smoothly and gracefully with my family doctor? Upon my return, it will be clear that she made a mistake in treating only my anxiety (which was due to symptoms), instead of treating the symptoms that led to anxiety. Yet, I believe that all doctors make mistakes and that she will learn from this. My menopause is premature (early 40's), and so I believe that was a factor in her being unable to see the diagnosis.
I guess I am looking for specific phrases or terms to say. I think it's possible that seeing me so normal and happy on this treatment will help her to see the validity of this new diagnosis.
IAAD. "Saw a specialist, she put me on 'X' and I feel like it's working pretty well." Your doctor will say "great!" and that will be that.
posted by killdevil at 3:35 PM on June 20, 2019 [14 favorites]
posted by killdevil at 3:35 PM on June 20, 2019 [14 favorites]
First off, I agree that you 100% do not need to worry about this. Half the people I know have some health condition or other that the first doctor they saw didn't catch. This is the whole reason we have specialists in addition to family doctors.
For what to specifically say: it's not clear whether you brought up your suspicion of early menopause when you spoke to your doctor last time. If you did bring it up, you can say "I tried the treatments you prescribed but they didn't help much, and I still suspected it could be early menopause, so I went to an early menopause specialist and they confirmed it." If you didn't bring it up, you can say "I tried the treatments you prescribed but they didn't help much and I felt like something more was going on, and I suspected it could be early menopause, so I went to an early menopause specialist and they confirmed it." Either way, I would be frankly stunned if your doctor had anything but a positive reaction to your getting a diagnosis.
posted by showbiz_liz at 3:40 PM on June 20, 2019 [2 favorites]
For what to specifically say: it's not clear whether you brought up your suspicion of early menopause when you spoke to your doctor last time. If you did bring it up, you can say "I tried the treatments you prescribed but they didn't help much, and I still suspected it could be early menopause, so I went to an early menopause specialist and they confirmed it." If you didn't bring it up, you can say "I tried the treatments you prescribed but they didn't help much and I felt like something more was going on, and I suspected it could be early menopause, so I went to an early menopause specialist and they confirmed it." Either way, I would be frankly stunned if your doctor had anything but a positive reaction to your getting a diagnosis.
posted by showbiz_liz at 3:40 PM on June 20, 2019 [2 favorites]
Your doctor is an expert on her thing, you're the world's greatest expert on you. She probably knows this.
posted by amtho at 3:41 PM on June 20, 2019 [3 favorites]
posted by amtho at 3:41 PM on June 20, 2019 [3 favorites]
If anything, I'd call the office in advance of the appointment to alert them that you're off the SSRI and are now on HRT -- if family doc isn't comfortable continuing that prescription, you might need to see an in-system ob/gyn. (Unless I'm misunderstanding what you mean by 'in-system,' and you're going to continue seeing the specialist.)
Edited: SSRI, not antidepressant
posted by Iris Gambol at 3:42 PM on June 20, 2019
Edited: SSRI, not antidepressant
posted by Iris Gambol at 3:42 PM on June 20, 2019
TBH, speaking as a person in treatment for anxiety, your fears about how your doctor will react sound like classic anxiety thinking to me. It's possible that your new treatment regimen hasn't fully kicked in yet and you are still experiencing some anxiety symptoms.
posted by showbiz_liz at 3:43 PM on June 20, 2019 [26 favorites]
posted by showbiz_liz at 3:43 PM on June 20, 2019 [26 favorites]
If the face-to-face bit makes you anxious, you could get the information to her ahead of time. You could send her an e-mail if her office does that, or have the specialist send in the test results.
posted by The corpse in the library at 4:00 PM on June 20, 2019 [3 favorites]
posted by The corpse in the library at 4:00 PM on June 20, 2019 [3 favorites]
Best answer: I would send her a quick email saying “I just wanted to give you an update on those symptoms we discussed. My gut told me there might be more to this than anxiety, so I went to see a specialist who diagnosed me with early menopause and put me on [medications]. They’ve really improved my symptoms and I feel so much better. Looking forward to seeing you for my next checkup on [date].”
posted by sallybrown at 4:37 PM on June 20, 2019 [3 favorites]
posted by sallybrown at 4:37 PM on June 20, 2019 [3 favorites]
Have the specialist forward your chart info to your primary care doc. It's a boilerplate form that will save you the hassle of broaching the subject and ensure that your doc has the complete, objective info she needs to give you proper care going forward.
posted by headnsouth at 4:42 PM on June 20, 2019 [6 favorites]
posted by headnsouth at 4:42 PM on June 20, 2019 [6 favorites]
It IS possible that your doctor will react defensively or in some way not productively/positively to receiving this information. Doctors are not flawless, they are humans just like everyone else. It has happened to me twice and in the first instance I decided to no longer see that doctor, half because it was inconvenient to me geographically to do so and half because I preferred to see the doctor who gave me the correct diagnosis, and I don't really feel like there were hard feelings on either side.
The second time the incorrect doctor was my mom and the less said about that, the better.
posted by poffin boffin at 5:12 PM on June 20, 2019 [4 favorites]
The second time the incorrect doctor was my mom and the less said about that, the better.
posted by poffin boffin at 5:12 PM on June 20, 2019 [4 favorites]
If you provided contact information for your PCP (often requested on new patient forms), your specialist may have already sent her chart info and/or a letter.
posted by elphaba at 5:29 PM on June 20, 2019
posted by elphaba at 5:29 PM on June 20, 2019
I’m not sure you being happy will convince her of the validity as much as the test results. That’s her language of evidence, in any case. Would the specialist have sent a copy of your records to your family doctor? She might already know. She needs to know your prescriptions have changed, in any case. She might know before you tell her.
Are you frustrated or mad at your family doctor? Are you looking for her validation? She missed something big, but you still want to see her, so I’d say treat this as if it’s not a big deal to her, as if you’re giving her an update: “So it turns out I’m in early menopause...”
posted by bluedaisy at 7:51 PM on June 20, 2019 [1 favorite]
Are you frustrated or mad at your family doctor? Are you looking for her validation? She missed something big, but you still want to see her, so I’d say treat this as if it’s not a big deal to her, as if you’re giving her an update: “So it turns out I’m in early menopause...”
posted by bluedaisy at 7:51 PM on June 20, 2019 [1 favorite]
If you otherwise feel comfortable with your doctor, then the first script is good. All you should need to do is just let them know.
However, if you feel this is a sign you don't trust or feel comfortable with your doctor, then find a new one. As a professional Sick Person, it's my experience that putting things onto mental health first and not exploring other things can be a bad sign. You can often have mental thing + body thing. But it's very important to manage or rule out body things.
It concerns me that you think your doctor may not think your current treatment is valid and may be worried about ongoing care and management with this doctor.
You can't single handedly change the medical environment or the doctor- but you CAN find a doctor you trust more.
posted by Crystalinne at 8:05 PM on June 20, 2019 [4 favorites]
However, if you feel this is a sign you don't trust or feel comfortable with your doctor, then find a new one. As a professional Sick Person, it's my experience that putting things onto mental health first and not exploring other things can be a bad sign. You can often have mental thing + body thing. But it's very important to manage or rule out body things.
It concerns me that you think your doctor may not think your current treatment is valid and may be worried about ongoing care and management with this doctor.
You can't single handedly change the medical environment or the doctor- but you CAN find a doctor you trust more.
posted by Crystalinne at 8:05 PM on June 20, 2019 [4 favorites]
Your doctor is not your friend. They are a professional whom you are paying. Just have the records sent from the specialist and mention it at your next appointment. There's no need to break it to them gently or anything, you are way overthinking this (and I am a world-class overthinker, so I recognize the symptoms!). Doctors are people, people are fallible, most doctors will just be glad you got an answer that's scientifically valid, and are feeling better. As long as you trust your doctor otherwise, there is no reason to be anything but polite and matter of fact about this.
posted by biscotti at 4:28 AM on June 21, 2019 [1 favorite]
posted by biscotti at 4:28 AM on June 21, 2019 [1 favorite]
Please keep in mind that for many women in menopause or perimenopause, anxiety and/or depression is very common and the treatment would be the same regardless of hormone levels. HRT doesn’t always solve these issues, although many women do find it helpful in reducing symptom severity. I say all of this to say that you are not quite correct in your thinking that somehow your PCP’s treatment plan was inappropriate, or that she “missed” something. My current case load features several menopausal and post menopausal women who are taking BOTH HRT and an SSRI.
posted by little mouth at 6:55 AM on June 21, 2019 [1 favorite]
posted by little mouth at 6:55 AM on June 21, 2019 [1 favorite]
Response by poster: FWIW, yes, I do have anxiety and will continue with treatment. I haven't stopped that medication. It's that the other symptoms associated with perimenopause/menopause were not treated at all by the SSRI. I've been helped 10x more by HRT than by an SSRI.
Yes, the doctor totally missed perimenopause/menopause. It wasn't on her differential at all. The eyes don't see what the mind doesn't think of.
I am indeed worried that the perception that I am 'anxious' will cause her to miss important signs in the future. Yet I view this mistake as part of 'training' the doctor that I am not just anxious, and to continue to look deeper in the future. Blaming physical symptoms on anxiety or depression is common in medicine.
My question might be more 'how do I continue to train this doctor to believe me?' than 'how do I break the news?'.
posted by dog-eared paperback at 7:46 AM on June 21, 2019 [2 favorites]
Yes, the doctor totally missed perimenopause/menopause. It wasn't on her differential at all. The eyes don't see what the mind doesn't think of.
I am indeed worried that the perception that I am 'anxious' will cause her to miss important signs in the future. Yet I view this mistake as part of 'training' the doctor that I am not just anxious, and to continue to look deeper in the future. Blaming physical symptoms on anxiety or depression is common in medicine.
My question might be more 'how do I continue to train this doctor to believe me?' than 'how do I break the news?'.
posted by dog-eared paperback at 7:46 AM on June 21, 2019 [2 favorites]
Best answer: My question might be more 'how do I continue to train this doctor to believe me?' than 'how do I break the news?'.
It's very possible that your doctor does believe you, and was just overtired the day she saw you and that's why she missed it. Or she was dealing with her own health problem and wasn't as focused on that one day.
None of that alleviates your own anxiety, I'm sure. I say that only to focus on the fact that there are other scenarios here, and my hunch is that you maybe didn't have enough time during your last visit with your doctor for you to get more of a read on where her head was at. If you'd maybe seen her sneeze a lot or something, you might have had the thought today that "oh, I bet that's why she didn't catch my menopause, she was probably stoned on cold medicine".
So maybe instead of thinking like "training my doctor to believe me", maybe try "make sure that I walk out of every visit feeling like I've gotten her full attention." That could simply be a matter of asking if you and she could arrange things so that you have an extra five minutes or so at the end of your visits to really talk things through so you're sure you and she are both on the same page. Maybe that means that you have to schedule your visits towards the end of the day, or first thing in the morning or something. Or maybe you could ask if you could do follow-up emails with questions if they come to you at like 3 am.
You absolutely have the right to ask for these things - EVERYONE does!
Good luck.
posted by EmpressCallipygos at 10:08 AM on June 21, 2019 [5 favorites]
It's very possible that your doctor does believe you, and was just overtired the day she saw you and that's why she missed it. Or she was dealing with her own health problem and wasn't as focused on that one day.
None of that alleviates your own anxiety, I'm sure. I say that only to focus on the fact that there are other scenarios here, and my hunch is that you maybe didn't have enough time during your last visit with your doctor for you to get more of a read on where her head was at. If you'd maybe seen her sneeze a lot or something, you might have had the thought today that "oh, I bet that's why she didn't catch my menopause, she was probably stoned on cold medicine".
So maybe instead of thinking like "training my doctor to believe me", maybe try "make sure that I walk out of every visit feeling like I've gotten her full attention." That could simply be a matter of asking if you and she could arrange things so that you have an extra five minutes or so at the end of your visits to really talk things through so you're sure you and she are both on the same page. Maybe that means that you have to schedule your visits towards the end of the day, or first thing in the morning or something. Or maybe you could ask if you could do follow-up emails with questions if they come to you at like 3 am.
You absolutely have the right to ask for these things - EVERYONE does!
Good luck.
posted by EmpressCallipygos at 10:08 AM on June 21, 2019 [5 favorites]
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posted by fingersandtoes at 3:28 PM on June 20, 2019 [92 favorites]