Excuse me, Doctor... but are All The Drugs right for me?
September 7, 2012 11:10 AM   Subscribe

I've decided to actually use my medical insurance as it was intended, rather than waiting for some body part to fall off. I have my first ever physical scheduled in 2 weeks. How do I bring up health concerns with my doctor in a way that doesn't make me sound like a hypochondriac with an internet connection?

I know you're not my doctor, but I want to know how to bring these things up without looking like I'm self diagnosing, drug seeking, or anymore crazy than I actually am.

I want to come in prepared, but not look like I've spent the time preparing a top 10 of my favorite diseases.

I have a few concerns that I want to look at, but i don't know how to bring them up.

Possible Gluten or Wheat Allergy: I try to keep a low carb diet and I've noticed I feel a lot better when i cut my carbs. I feel like crap if I get carbs from things like pasta, breads, etc... but I feel fine if I'm getting them from fruits, vegetables, or even rice.

Adult ADHD: I'm late for everything, I'm either super focused on the wrong thing or trying to do too many of the right thing at once. I show a lot of classic signs for having ADHD.

Problems with my antidepressants: I need to know how to bring up to him that when i take my antidepressants and don't forget to take them regularly, I lose the ability to have an orgasm. I have no problem getting or maintaining an erection... but I just keep missing the best part, giving up before I actually reach it. Hell, sometimes I "forget" to take my Celexa just so I can get off.

I have some other issues, but these are the main ones. Any suggestions on how to broach the subjects in a constructive manner?
posted by aristan to Health & Fitness (18 answers total) 5 users marked this as a favorite
Best answer: Gluten/wheat allergy: Describe the symptoms you're having and exactly what you've done to "test" this allergy. The doctor will most likely want more testing than just the home-grown variety.

ADHD: You mention you're on antidepressants, so why aren't you talking to your pdoc about this?

Antidepressant sexual dysfunction: Absolutely bring this up. If you're having a side-effect of medication, your doctor and/or pharmacist is who you tell. Again, why aren't you mentioning this to your pdoc who prescribes this?
posted by xingcat at 11:16 AM on September 7, 2012 [1 favorite]

Best answer: Make a list of symptoms for each thing. Rate the things by how much they bother you (I'm guessing that's the Celexa issue?) Put the list of symptoms in order of severity. Try to write down how long they've been happening. Start by saying "Okay, I don't want to be all hypochondriac here, but it's been a long time since I've had one of these kinds of evaluations, and so I have a lot on my mind."

Whoever is prescribing the Celexa needs to know about the side effects more than your (brand new?) primary care physician. There are many antidepressants in the world, and not all of them cause this problem.

You may need to be ready to schedule a longer appointment. Most doctor's appointments are timed so you can cover one or maybe two issues, and quite frankly, "a complete physical" counts as one issue.

You may also need referrals - make sure to ask about that before you leave. Primary care physicians don't normally do a lot with allergies or psychiatric evaluations.
posted by SMPA at 11:17 AM on September 7, 2012

Response by poster: Just want to clarify that it is the same doctor I've been seeing, but I've only seen him for issues that were currently in progress rather than some sort of preventative care. Like, I'd see if I have the flu, but never to get a flu shot. He's also the one that prescribed my anti-depressants.

This will be the first time I've actually seen a doctor when I wasn't "sick".
posted by aristan at 11:21 AM on September 7, 2012

Best answer: "I am concerned about looking like a hypochondriac with an Internet connection, which is really not the case. I have this list of concerns. Ready?"
posted by theredpen at 11:21 AM on September 7, 2012 [3 favorites]

1) He may or may not think much about the gluten/wheat bit. It's definitely a fad diet. Celiac disease is real, but most people don't have it. Feel free to bring it up, but don't be surprised if he orders blood tests. On the other hand, if you're successfully able to manage your perceived symptoms, you may just leave it at that.

2 and 3) These are real, legitimate concerns, but you should probably ask for a referral for a psychiatrist or other specialist. Family doctors and even internists aren't really who you want to talk to about this stuff. They'll prescribe anti-depressants, but they don't generally have the training or background to actively manage or moderate your doses.
posted by valkyryn at 11:22 AM on September 7, 2012

"I am concerned about looking like a hypochondriac with an Internet connection, which is really not the case. I have this list of concerns. Ready?"


I have a (couple) chronic condition(s) for which I take meds. There have been a few times in my life that I've had to go to a new doctor when I'm not sick and not in need of a physical just so I can have someone write me a prescription refill. I always bring it up first, then chuckle and say, "nothing like a patient displaying drug-seeking behavior, amirite!?"

This usually amuses the docs and makes them more receptive when I go on to relate my symptoms, since I've already addressed the potentially sketchy thing that they're thinking.
posted by phunniemee at 11:26 AM on September 7, 2012

Best answer: I find it best to go to the doctor and describe my symptoms rather than present a diagnosis. For example, instead of saying, "I think I have a gluten intolerance," I would say, "I've noticed that I feel better when I cut out these foods, but I don't notice a difference when I cut out these foods."

Likewise, I would describe the symptoms that make you think you have ADHD, and perhaps ask the doctor if s/he thinks an ADHD screening is appropriate, given your symptoms - rather than saying - "I think I have ADHD."

That way, you're providing information, and the doctor is the one doing the diagnosing. I find that doctos often appreciate this approach.
posted by insectosaurus at 11:30 AM on September 7, 2012 [2 favorites]

I always bring it up first, then chuckle and say, "nothing like a patient displaying drug-seeking behavior, amirite!?"

Ehhh, don't do this. It could go very wrong.

You don't seem like a hypochondriac. That seems like a reasonable list of concerns. (It does sound like you're managing your wheat issue fine on your own, so I'm not sure what medical intervention you're looking for there.)
posted by purpleclover at 11:34 AM on September 7, 2012 [1 favorite]

write up an introduction to the doctor. Lay it out in simple list form, or overlay clip art on an image of the body (bubble next to head with text for head issues, shoulder for shoulder pain, etc, etc.)

Go with a brief list of talking points, concerns, questions, and notes to help you remember to address things (I do this myself, and still managed to not tell the doc about a pre-existing condition I remembered about for over a year).
posted by tilde at 11:36 AM on September 7, 2012

Best answer: Dude,

Every time I go to the doctor I bring a list. There's something about that environment that makes me lose my brain.

Don't worry about looking like a hypochondriac, you have legitimate concerns.
posted by Ruthless Bunny at 11:42 AM on September 7, 2012 [2 favorites]

Best answer: I did this not too long ago. Saying "I think I have X because of Y" was well received and the presence of a list was not mentioned by the doctor. They are trained to deal with people who are not also doctors. Mentioning that you are anorgasmic when taking an anti-depressant is to mention something super common.

So relax, read your list and work with your doctor. If they dismiss your concerns because they are on a list, time for a new doctor! You pay them. You can fire them.
posted by munchingzombie at 12:07 PM on September 7, 2012

Wheat/Gluten Allergy: This is one I've dealt with and I've had varying degrees of success. First thing I'd say is "Don't give up!" I spoke to two doctors about this issue before they took me seriously. The first dismissed the notion out of hand. The second said "Yeah, that sounds like an allergy. Avoid it." and when I asked if there was something more scientific that we could do said there wasn't. The third, finally, sent me off to the allergy clinic for full testing. Since then I've been getting allergy shots and while I have no idea what the outcome will be - I'm actually getting real treatment for a real problem which I had identified years ago. Here's what I would do if you think that your doctor will want real data: keep a food journal. Identify times when you felt rotten, and bring that with you.

Anorgasmia: That's a side effect. Don't be afraid to express how that side effect is interfering with your ability/desire to keep taking your medication as prescribed. That's what your doctor needs to hear about it.
posted by jph at 12:58 PM on September 7, 2012

Best answer: Wow, are you me? My doc wouldn't order a test for gluten sensitivity for a couple of reasons. 1. He claimed that people with that sort of issue have problems with nutrient absorption and tend to be underweight, which I'm certainly not, 2. The test can be fairly expensive and 3. If I found I felt better without wheat in my diet, then I should just avoid it.

I just asked how I could get evaluated for ADD & my doc described the process to me. No problems getting diagnosed & treated.

I have brought in lists of my issues before and I've never had any problem with the doctor taking my symptoms seriously.
posted by Kitty Stardust at 1:10 PM on September 7, 2012

Best answer: Agree with others that this isn't a crazy list. As far as gluten goes you could have Celiac - you have to be eating gluten for the blood work to show antibodies if that's the case. If you don't have Celiac and you feel better when you avoid gluten don't eat it! I'm gluten intolerant but don't have Celiac. Never bothered to get tested for allergies or gluten sensitivity because one can react to gluten without ever having a positive test and if you feel better when you don't eat it it's hardly necessary to have a diagnosis. This is not the care re Celiac though since you need to be a LOT more meticulous about avoiding gluten if that's what's causing your trouble.

RE ADHD - do you feel more focused when you don't eat gluten? People with Celiac disease often have cognitive/attention issues when they consume gluten. [I have a kid with Celiac] Obviously doesn't preclude having ADHD as well but something to be aware of.

The orgasm woes are a very common side effect from many anti-depressants. Changing drugs can fix it.
posted by leslies at 3:18 PM on September 7, 2012

(As an aside, if your health insurance covers preventative visits at 100%, you need to be careful how the doctor codes the visit. If the doctor codes the visit with a diagnostic code that is not the "preventative care" code, then your insurance will likely charge you for the visit, even though the diagnosis occurred during a physical. If this is an issue for you, make sure you ask the doctor and the folks who do the coding about it.)
posted by leahwrenn at 3:19 PM on September 7, 2012

Best answer: As a corollary to leahwrenn's comment about insurance: if your doctor codes the visit as preventive, but also orders tests that are diagnostic (like the Celiac test) then those tests may not be covered by insurance.

If you want to be sure, you can call your insurance company (or look on the website) and see if they have a chart with exactly what is covered in a preventive visit. If so, then ONLY those things are covered. You are allowed to mention any other concerns to your doctor, but if there will be a procedure or test to diagnose/treat those concerns, the insurance company would prefer you to schedule a separate visit for those items and have them coded differently.

YMMV, but I ended up paying over $600 for tests for vitamin D and thyroid, which I and my doctor thought were perfectly reasonable to be part of a free wellness check, but my insurance company disagreed. They were also not allowed to be paid out of my HSA, because the insurance company labeled them "ineligible" procedures, and HSA only paid for "eligible". I can't tell you how many times I called the insurance, the HSA, and the doctor to get things recoded or explained - didn't matter.
posted by CathyG at 10:07 AM on September 8, 2012

Best answer: doesn't make me sound like a hypochondriac with an internet connection?
looking like I'm self diagnosing, drug seeking, or anymore crazy than I actually am.
prepared, but not look like I've spent the time preparing a top 10 of my favorite diseases.
Possible Gluten or Wheat Allergy, Adult ADHD, Problems with my antidepressants

Your doctor should listen to you and respect your concerns. Anything else is unacceptable. I've had doctors who blew off my concerns; I don't go back. My favorite docs listen, ask questions, and follow up. Your concerns are valid, and you should be able to get help with them.

fyi, SSRIs are noted for causing sexual dysfunction.
posted by theora55 at 4:23 PM on September 8, 2012

Response by poster: Just saw my doctor this morning and he answered all my questions and took me serious.

Basically he helped me decide that lasting 2 hours in bed is a good trade off for not crying about nothing. He didn't seem to mind my current method of handling it... which is if I know I may very well find myself in a sexual situation, I will skip a dose and it seems to help. Then, right back on it afterwards. This would be harder (wow, punny.) if I were in a relationship, I guess... but hopefully if I were in a relationship I could talk about it. (He didn't completely LIKE this method, but he understood it if nothing else.)

I'm starting Concerta for ADD and I'll see him again in a month to find out how it's working.

And he asked me to try cutting out dairy and wheat for awhile before he runs official tests on me for allergies. He said it sounded more like a dairy allergy (I LOVE CHEESE) than a wheat allergy to him. He said that for some people, it wasn't an allergy, but more that the body couldn't process a high number of carbs and just push them out of their system.

Thanks everyone for your help!
posted by aristan at 12:13 PM on September 27, 2012

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