Anxiety vs. Head Trauma vs. "Something Else"
September 8, 2014 11:25 AM   Subscribe

It's been 2 years since a minor head trauma (book fell on head, no concussion). My partner occasionally complains of headaches and/or dizziness. When she has talked to doctors about this she is either told to lose weight or given an anti-anxiety pill. How do I help my partner find and communicate with a primary care Dr. who will not be dismissive of her symptoms?

I have almost posted this question a dozen times over the past year. I'm trying really, really hard to be sensitive, open-minded, and –above all– helpful to my beloved partner (let's call her MC) and spouse but I'm just at a complete loss.

Two years ago MC was rummaging about in the office and book fell on her head. It was a fairly average-sized hardbound book, and it fell from a height of less than 24 inches, smacking her on the top of the head. She did not receive a concussion from this as far as we know (I remember checking for pupil dilation later in the day and everything was fine)...however a week later she complained that the area was sensitive and she was getting headaches. I prompted her to get an appointment but she put it off, assuming it was a temporary thing. The next week, still feeling the pain was there, she went to the Doctor's. I was not present at this appointment so I don't know exactly what was communicated but the end result was that the Dr. told her it was "nothing to worry about" and then gave her a prescription for some anti-anxiety meds.

MC never took the meds. She was discouraged and felt that the Dr. had dismissed her symptoms as being merely emotional or "all in my head". In an effort to be supportive I tried to do some research and found nothing conclusive. I said that I would probably trust the Dr. since she has more knowledge in this field than I have. MC told me that this made her feel as if I was "taking the doctor.'s side" and not really listening to her. I apologized and promised I would try to listen better. The episode passed and no further doctor. visits were planned.

A few months later, MC felt the symptoms again, and went to a doctor. again. This time it was a new doctor., one I had visited before and liked. MC didn't like him. When she told him about the issues his suggestion was that she needed to lose weight, and that he could prescribe some anti-anxiety meds if she wanted.

These interactions with medical professionals have played out a few more times, more or less in like manner, for the past two years. When these happen, I have found that only support I can give is to listen quietly and not offer up any thoughts about the merits of the doctor.'s diagnosis. It feels very unproductive; either MC is continually getting biased diagnoses from these different M.D.'s or there really is an anxiety-related component that needs to be explored with a mental health professional. I can't make this suggestion at all; to do so would immediately result in the conversation ending.

I desperately want MC to feel well.

I should also note that MC's mother had colon cancer about 8 years ago and it was a very scary time for the whole family. MC often expresses fears that she has cancer or some other life-threatening illness hiding inside of her, undetected.

Last night she said to me "I just feel in my gut that something is wrong with me, but I can't explain it and everyone thinks I'm crazy or stupid or fat." It's very disheartening. I don't know what to do. On the one hand, it's entirely possible that these are psychosomatic symptoms and MC really does need some anti-anxiety medicine or some kind of therapy to work through these problems. On the other hand, I think it's entirely possible that a combination of institutional bias and MC's difficulty describing her symptoms are resulting in improper diagnoses and insufficient care. But I am simply not equipped to make that call. I don't have the knowledge or experience to say "yeah, that doctor. is being a sexist jerk and we need to find another doctor."

Are there any resources available to help patients better communicate with their doctors? Or guides, or advocacy groups?
posted by Doleful Creature to Health & Fitness (27 answers total) 2 users marked this as a favorite
Best answer: Can you not go in the exam room with her? I am fed up enough with the "oh, it's because you're fat" bullshit enough to get very unpleasant and not care if the doctor thinks I'm a fat bitch, but if she needs help advocating then go in with her.

Sadly, if you're a man, she's more likely to be taken seriously if you're in the room. But even if you're not, you're a witness and can be the one who says "please explain to me how being fat/anxious causes this specific issue, and if you cannot please do whatever our insurance company requires to get a neuro consult so we can get this over with."
posted by Lyn Never at 11:29 AM on September 8, 2014 [6 favorites]

Best answer: I understand where the doctors are coming from. It seems pretty unlikely that a bump on the head like you describe would cause permanent damage. Has she tried leaving out the book story and just saying that she has headaches, etc, and is not sure why? That's still the truth and might get a better response. Otherwise, maybe you can frame therapy as something you want. "I'm just feeling bad about this and need some professional advice. I'd like it if you'd come, but of course you don't have to."
posted by amodelcitizen at 11:45 AM on September 8, 2014 [25 favorites]

I had a family member who ended up have a physical brain problem - bulging and then leaking blood vessel (aneurysm). They ended up going from doctor to doctor being dismissed w/ scripts for anti-depressants and other medication and ended up a few years later getting emergency brain surgery after almost dying.

Some take aways from their experience:

1) Moving from doctor to doctor did not help get to an answer since all doctors seem to start at he same place at the trouble tree and walked them through all the same questions and processes.

2) Staying with a single doctor may have allowed them to get higher up the trouble tree.

3) The most common thing is a "horse" not a "zebra" so, it's not unexpected to hear "lose weigh", "you are likely anxious" since those are much more common sources of problems than a serious phsyical brain problem.
posted by bottlebrushtree at 11:45 AM on September 8, 2014 [5 favorites]

Ever heard "If you run into an asshole in the morning, you ran into an asshole. If you run into assholes all day, you're the asshole." ?

If it'd been one or two doctors I'd give you partner the benefit of the doubt. At some point though, they may have a point. Having had a partner with 1) undiagnosed-at-the-time mental illness and 2) terrible migraines due to weight-related hormone issues, I sympathize with you. If you could convince your partner to take the anti-anxiety meds for a little bit, it would definitely help her have some perspective, but the odds aren't good.
posted by Oktober at 11:47 AM on September 8, 2014 [4 favorites]

Best answer: Lyn Never has it. I am your partner if you add minority to the mix of fat and female--and I was getting the dismissive (fat, over-reacting, nothing wrong with you, here's an Rx for anti-depressant/anti-anxiety meds) brush-off from doctors for my health problems *until* I started bringing my tall, white, male partner with me to doctor's appointments. Yes, he came into the room with me and listened and asked questions and bore witness to the proceedings. Suddenly doctors were taking more time to examine me and discuss my problems. Suddenly there were reasons for their decisions that they had time to explain in detail. Suddenly there was advice that went beyond lose weight. Suddenly they wanted to see me for follow-up appointments to make sure that what they were doing was working. What a surprise. All because I brought someone, a very privileged someone, into the appointment with me.

So yes, I believe your partner is getting the brush off and is not receiving adequate care from her doctors at this point.

So yes, if you have any amount of privilege (and even if you don't, often a witness will be enough to prompt a different response from doctors), then offer to go with your partner and advocate for her. And yes, ask for a referral to a neurologist to get things completely checked out.
posted by GoLikeHellMachine at 11:58 AM on September 8, 2014 [16 favorites]

I would definitely try to get an appointment with a neurologist. Have MC keep a log of what she's feeling and when, so she can go in with some solid data for the doctor to look over. I hope she will find the consult helpful at getting at the root of what is causing her issues, and accepting it.
posted by ThePinkSuperhero at 11:59 AM on September 8, 2014

You don't specify whether any of these doctors were regular family doctors/PCPs, or if any of them were neurologists. (On preview, agreeing with Lyn Never and GoLikeHellMachine on this point) If she hasn't seen a neuro yet, get in to see one. Go back to one of the dismissive doctors for a referral if your insurance needs one.

The key is to explain the symptoms first - frequent headaches and dizziness. Record the frequency of the symptoms, as well as whether they occur separately or always together, or one right after the other, etc. Then, after you've described the symptoms and how/when/how often they show up, you can reveal that they only started occuring after the incident with the book. By documenting a history of symptoms, going back to a specific origin point, the neuro will probably take this a bit more seriously. If insurance will cover a CT scan to rule out any internal physical issues, that alone may provide some relief even if this is only psychosomatic.
posted by trivia genius at 12:00 PM on September 8, 2014 [1 favorite]

Frequent headaches and dizziness = time for a neurologist. Take this from someone who had a headache for a YEAR before getting it resolved.
posted by joan_holloway at 12:07 PM on September 8, 2014 [1 favorite]

You don't need to determine if the doctors are right or giving her the brush-off or something in between. Solving this is not your job. Supporting your partner is your job here. That does not mean that everyone else is wrong and that she is right. It means that she is having a crappy experience and you sympathize with that, no matter what is causing it. Suggesting solutions is not the only way to support someone and if she doesn't want to hear your solutions anymore, she doesn't want to hear them. Health anxiety exists in both sick and healthy people.

help patients better communicate with their doctors
A symptom diary could help her organize her thoughts and show patterns of timing, intensity and duration of each episode.
posted by soelo at 12:13 PM on September 8, 2014 [2 favorites]

Best answer: I've had a headache for over 20 years, and nobody can figure out why, so I have a lot of experience with a medical problem that is hard to pin down, and with doctors either dismissing it or really missing the mark with their suggestions, or just getting tired of trying to help me with it. Here's my advice:

1. Someone up-thread suggested dropping the book piece of the story. I'd agree with this since if the doctor thinks she's saying, "It's all because this book fell on my head!" they'll be dismissive. She should do her best to create a history, though, that includes anything she's tried and whether it's helped, whether that's over the counter meds, prescriptions, herbs, massage, heat or ice, and so on.

2. She should track her symptoms. It will be helpful for her, and for the next doctor she talks to, if she has some idea whether her headache symptoms correlate with her menstrual cycle, changes in the weather, sleep patters, specific foods, and, yes, anxiety. It doesn't have to be super-detailed; I have been keeping a log for the past few months where I simply check a box for each day about whether I had a bad enough headache to interfere with my day (versus being able to go about my normal business); whether I took any of my prescribed headache meds; and whether the meds helped. She might pick a couple of things to track to begin with, like menstrual cycles and anxiety for instance, or she might just track her headache level on a numerical scale and make notes on any day it's bad ("had wine with dinner" "might be premenstrual" "didn't sleep well" "worried about X"). A log will be helpful for her, but also for doctors.

3. If her symptoms are interfering with work, social events, keeping up the house, and so on, it really helps bring it home to doctors to say so.

4. I have been seeing a headache specialist the last few years. This is a lovely thing because he really gets it. I recommend she find her way past a general practitioner to a specialist if she can. It has made a huge difference for me, not only in pain management but in feeling like I have been listened to, understood, and supported, which, if you're going to have pain, makes a huge difference.

5. Sadly, a lot of people who are prone to headaches of various kinds are also prone to anxiety, and to being very sensitive both emotionally and physically, which makes it easy for us, our loved ones, and certain doctors to dismiss our headache symptoms. Your mileage may vary, of course, but I know it felt really good to me when I was new with the headache specialist and I started to explain that I often respond to medications at lower-than-clinical doses, and am prone to side effects, and he said, "Oh, yeah, all my patients are like that. Sometimes I want to post a sign over the door that says Through This Door Walk The Most Sensitive People in the World."

6. Headaches are complicated and hard to treat. Figuring them out involves a lot of ruling out of this and that (brain scanned multiple times? check! spinal taps? check! blood tests of all kinds? check!), and there may never been a clear diagnosis. I've ended up over the years with diagnoses like "atypical migraine" or "migraine without aura" or currently, "chronic daily headache," which just seems to mean "this patient has a headache every day." My headache has clear triggers, but they are multiple triggers including stress, poor sleep, changes in the weather, perfumes, hormones, and "miscellaneous," so even knowing the triggers doesn't mean they can necessarily be avoided.

7. Do go with her the next time she talks to a doctor, if you can. Talk ahead of time about what she needs to make sure the doctor understands, and what questions she might ask. If weight loss is suggested again, she or you might say, "OK, but in the meantime, what can we do to improve the symptoms?" If an anti-anxiety medication is suggested, she or you might say, "OK, and if we try this, how long until we know if it's helping? Should we come back in two weeks, a month, 90 days, if we're not seeing improvement?" Or she could say, "I'm not opposed to talking about my weight or my anxiety, but right now I'd really like to focus on these headaches I've been having."

8. Again: get past the GPs. In my experience, a lot of general practitioners have one or two possible headache medication in their repertoire, and one or two anxiety meds. When I started insisting on seeing a psychiatrist for psych meds, and a headache specialist for headache meds, I found myself working with people who have a very deep and broad understanding of the available options, and also a better understanding of possible side effects.

In the case of headaches, the options include meds aimed specifically at migraines, for instance, but also medications developed for other purposes that have been found to be efficacious for some people with headaches, including some antidepressant and anti-anxiety meds, high blood pressure meds, anti-seizure meds, steroids. My neurologist interrupted a recent bad flareup by putting me on an anti-psychotic medication for three days. There is a lot of trial-and-error involved in figuring out which medication or combination of medications, trigger avoidance, and lifestyle changes will bring relief. I've had a number of doctors over the years who tried out their one or two anti-headache meds, and then threw up their hands when they didn't fix me. Not my neuro! He's in it with me for the long haul.

I hope this is helpful. I went on a bit. Good luck to you and your SO. I understand how frustrating this can be for both of you.
posted by not that girl at 12:18 PM on September 8, 2014 [10 favorites]

Anxiety can cause dizziness and headaches, and this does not mean she's imagining it or that it's all in her head. It could be general anxiety, or more likely, anxiety about the book falling on her head and possibly causing damage. It could also be a cause unrelated to anxiety (most of which are not serious, although the doctors can help you rule out the few that are). Headaches can be caused by about a million things including things as mundane as eating a food that doesn't agree with you, and dizziness is almost as bad.

An easy way to narrow it down is taking the anti-anxiety meds she was prescribed next time she gets a headache/dizzy spell and see if that helps. If it doesn't, she tells the next doctor that she tried the anti-anxety meds and they did nothing - then she won't get another anti-anxiety prescription. The doctors are all saying the same thing for a reason - it's a common explanation, and one that's easy to rule out with the meds.
posted by randomnity at 12:18 PM on September 8, 2014 [3 favorites]

Seconding the "try the anxiety meds to rule them out" suggestion. Even if the headaches are caused by a concrete physical injury, it's possible that a benzo/muscle relaxant will help, and that can narrow down the cause. My gf has headaches caused by some fucked-up jaw surgery - her jaw and neck muscles spasm, and it gives her headaches. She has a short-term anxiety med that she takes when they get bad, and it relaxes the muscles enough to ease the headache. She's also doing a variety of physical therapy-related things to fix the source of the problem, but having a tool to manage the symptoms is without question a good thing.
posted by restless_nomad at 12:29 PM on September 8, 2014 [2 favorites]

The doctors are all saying the same thing for a reason - it's a common explanation, and one that's easy to rule out with the meds.

That is key to me - before your SO can decide the doctor's don't know what they are talking about and ignore their first stage of advice, you (and they) need to rule out the obvious. It may well be anxiety related, in which case the meds will tell her that if they work. If they don't work, then it isn't and anxiety is ruled out but then the next approach is NOT to switch doctors constantly and start the process again, but elevate the issue by saying "Ok, anti anxiety meds didn't work, what's next".

The common first step between so many doctors means it is likely a common cause, rather than them all thinking your SO is making it up. Personally, I would find it unlikely that a minor issue such as that was the cause of it all (especially after so long and so intermittently), and it may be that your SO just remembers the event as being near the start of the headache and it is completely unrelated. But she has it linked in her mind to it (not unreasonably perhaps, but it is not definitely the cause).

As mentioned - stop mentioning the book. Just mention the recurring headache and maybe just (no matter how much it seems unlikely to MC) try the first stage meds. It can't be discounted as unrelated (from her view or the doctor's) until she tries the most likely cause from a medical perspective.

She was discouraged and felt that the Dr. had dismissed her symptoms as being merely emotional or "all in my head".
In the nicest way, she isn't being reasonable here. Just because a Doctor (and now several doctors) sees the situation differently to her in terms of cause and treatment doesn't mean anyone is dismissing her or 'taking sides'. It suggests more strongly that she has no idea what is wrong with herself and would be best advised following the diagnostic process (which may mean taking stuff that initially doesn't help) to find the REAL cause, rather than being convinced that being given something she doesn't feel she needs is marginalising her in some way.
posted by Brockles at 12:30 PM on September 8, 2014 [7 favorites]

Ativan (if that's what your partner has been prescribed) is actually given for dizziness and vertigo, so it's not necessarily because doctors think she's anxious. If dizziness is a symptom, Ativan actually helps relieve it in many cases.
posted by xingcat at 12:49 PM on September 8, 2014 [3 favorites]

I think an unexpected blow to the top of the head from a book falling a couple of feet might be more than enough to knock some of her otoliths out of their proper locations into her semicircular canals, and that this could account for the dizziness and possibly also the headaches.

And there is a fairly easy way to treat that: the Epley maneuver
The Epley maneuver or repositioning maneuver is a maneuver used to treat benign paroxysmal positional vertigo (BPPV)[1] of the posterior or anterior canals.[2] It works by allowing free floating particles from the affected semicircular canal to be relocated, using gravity, back into the utricle, where they can no longer stimulate the cupula, therefore relieving the patient of bothersome vertigo.[2][3] It is often performed by a medical doctor, occupational therapist, audiologist, chiropractor, or physical therapist, after confirmation of a diagnosis of BPPV using the Dix-Hallpike test and has a reported success rate of between 90–95%.[4][5][6] This maneuver was developed by Dr. John Epley and first described in 1980.[7] Physiotherapists and some chiropractors now use a version of the maneuver called the "modified" Epley that does not include vibrations of the mastoid process originally indicated by Epley, as they have since been shown not to improve the efficacy of the treatment.[8]
I think you could help her find an M.D. who has a lot of experience treating BPPV, see if she fits that diagnosis, and then find a qualified expert to perform the maneuver.

I don't know whether headaches are a recognized symptom of BPPV, but a friend of mine developed BPPV and migraines after a whiplash accident, and the Epley apparently dealt with both.
posted by jamjam at 12:57 PM on September 8, 2014 [1 favorite]

Best answer: She was discouraged and felt that the Dr. had dismissed her symptoms as being merely emotional or "all in my head".

Whatever else may be going on, it sounds like she imagines the right doctor will immediately ID one specific, treatable thing as the cause of her headaches and fix that. (Allowing her more time to focus on the other things she's worried about.)

Headaches are not easy and it's obvious her mother's illness did a number on her. That's a real trauma. As in could cause post - traumatic issues that would benefit from professional help.
posted by Lesser Shrew at 1:00 PM on September 8, 2014 [1 favorite]

Response by poster: Thank you everybody, so far, for all of the insights and ideas. It's very helpful. Couple of follow-ups:

1. She has only been to see GPs, no specialists.

2. Several answers have hinted at some elements that I realize now I should have included in the original question:

- Her Mormon* upbringing, coupled with a family history of alternative medicine practices, seems to get in the way of discussing evidence-based or diagnostic-process based methods. I realize this sort of challenge is beyond the scope of a doctor and the suggestions regarding therapy are becoming more compelling.

- In the past I've hesitated going to exams with her because that felt weirdly possessive and over-protective and I guess I just didn't want to be "that guy" who is all "this is MY WIFE, SIR"...I don't know. From some of the answers it seems like maybe we should consider that as well.

3. Tangentially from do you tell someone "in the nicest way possible" that they are being unreasonable? That seems impossible to me.

*I'm Mormon too but am hella skeptical and not a very "faithful" member
posted by Doleful Creature at 1:27 PM on September 8, 2014 [1 favorite]

It's worth noting that a pervasive belief that something is wrong with one's health is a real symptom that something is wrong, and also one of the diagnostic criteria for depression. I'm not saying, oh, maybe your partner is just depressed to dismiss things. After all depression a serious physical illness of the brain, and depression is an illness that can lead to incredible suffering and sometimes even death. Besides, there are many other problems that also have that symptom. Another example is chronic shortness of breath, caused by asthma. If she says she is sick, then she is sick. Period.

The only reason you want to find out how much of her feeling is psychological is so that you can get a handle on treating it. It could easily be that none of it is psychological. If she were my partner I would encourage her to take a test of the anxiety medicine, to see if it changes her symptoms in any way. Then she can report back to the doctor.

As a migraineur I encourage you to look into the possibility that migraines may be the problem. Not all migraine headaches are excruciating. There are people who have migraines with no pain whatsoever, so being functional during an attack does not rule out it being migraines. Migraines can also result in funny psychological or physiological symptoms.

There are very many possibilities. The important thing is that you want to support her and help her find the source of the problem.
posted by Jane the Brown at 1:29 PM on September 8, 2014 [1 favorite]

Best answer: I second the suggestions to offer to go with your wife to her next appointment, and to ask for a referral to a neurologist or a headache specialist. The fact that your wife feels strongly that something is wrong with her but no one can see it--boy can I relate.

(I didn't have headaches but soul-crushing fatigue and some other stuff. About 15 years later, I finally got a diagnosis. I have lost track of how many doctors suggested it was all in my head. I did a few years of therapy! And it turns out I was right, something was very wrong with my body. Also, nothing will mess with your emotions quite like being told your physical pains are "all in your head" when you know in your gut that there's something wrong.)

Encourage her to keep a headache log as described above, and to include details about how this impacts her life. When she has a headache, can she not cook dinner? Does she need to lie down? etc.

Be prepared for the medical appointments with lists of symptoms and questions so nothing gets forgotten or brushed aside.
posted by purple_bird at 1:38 PM on September 8, 2014

And there is a fairly easy way to treat that: the Epley maneuver

All of the doctors I have seen in recent years have said that the Semont one is apparently better for BPPV, so it can't hurt to try both.
posted by poffin boffin at 1:49 PM on September 8, 2014 [1 favorite]

Best answer: - In the past I've hesitated going to exams with her because that felt weirdly possessive and over-protective and I guess I just didn't want to be "that guy" who is all "this is MY WIFE, SIR"...I don't know. From some of the answers it seems like maybe we should consider that as well.

I'm a youngish white woman and doctors (both male and female) gave me the brush-off until I started prefacing things with "my father is worried because..." or even "my friend said he thought..." It's demoralizing to realize that what I say apparently matters much more when it's corroborated by (even an absent) man, but whatever works. I do think that it's likely to make a practical difference to your SO to have you there in the appointment as a witness and to corroborate her story if possible/necessary/appropriate. I doubt that doors will suddenly fly open or the doctor will pull a magic bullet from her white coat or anything, but I think that it might change the tone of the appointments considerably.

Also, she could have a physiological problem *and* be dealing with, for example, trauma from her mom's death. At this point, after dealing with headaches and pretty tough life circumstances for a couple years, I think it's very likely that she has anxiety. But that doesn't mean that the headaches aren't *also* stemming from a physiological cause. Nor does that mean that her anxiety isn't also exacerbating a physiological health problem. Ill-health and stress in one area usually exacerbates any health problems and stress in other areas of a person's body/life, so be prepared to use a multi-pronged approach to dealing with this problem (eg, lifestyle changes *and* specialized treatment for the headaches *and* anxiety medication, etc).

Other things that helped me in terms of dealing with doctors: telling them everything I'd tried, which included everything that the previous doctors had suggested. I would encourage your SO to at least try out the relatively low-risk treatment options that these doctors are apparently keen on, like the anxiety pills and "losing weight" (or, imo more importantly, exercise and rest). Not because those things will necessarily get rid of the headaches (though maybe they will! which would be great!), but because that will show doctors that she's really trying in good faith to follow their directions but still needs help. Something else that might get her more traction with doctors is to clarify to them that she *doesn't know* what the cause of the headaches is, but that the headaches are compromising her quality of life (she should be specific as to how) and that she needs their help because she's in pain and nothing that she's tried on her own has worked (including, at that point, the treatments that the other doctors have suggested).

Also, the feeling that something's wrong, which is sometimes listed as "malaise" if you're looking at lists of symptoms, *is* a symptom of various ailments. As far as I know, the range of what it may be related to is really, really broad (I've even seen it on lists of lupus symptoms) so it's probably not all that useful in terms of figuring out exactly what's going on. However, it's not something to just write off, just like her other symptoms aren't things to just write off. If she refers to it as "malaise" to doctors, maybe that would also be more communicative than trying to describe it more generally?
posted by rue72 at 2:33 PM on September 8, 2014

Is religion making her adverse to seeing a mental health professional?

The way you describe her fears makes me think a disinterested 3rd party could help. And any decent therapist would advise going step by step to rule out/find medical issues.
posted by Lesser Shrew at 3:00 PM on September 8, 2014

"I just feel in my gut that something is wrong with me, but I can't explain it" sure sounds like anxiety to me. Maybe there really is something medically wrong; maybe there isn't. The anxiety is worse when you don't actually know, right? So I think you can be supportive by telling her it's completely understandable to be anxious about the possibility that there could be something medically wrong. It's not "crazy" anxiety; it's reasonable to feel that anxiety. But being afraid to follow through on getting answers is not going to resolve the "what-if?" anxiety, and it's not going to resolve the possible medical problem, either. So maybe approach the possibility of therapy from a standpoint of getting some tools to help her be brave enough to face the medical establishment until she gets some answers.

Maybe she'd be willing to talk to a Mormon therapist. This guy seems to do a reasonable job on his blog of meeting Mormons where they are with their jargon, and gently introducing basic therapy concepts in a way that won't scare them, like in this question.
posted by Bentobox Humperdinck at 5:04 PM on September 8, 2014 [1 favorite]

My mother got the brushoff from her doctor for three years that it was her back and not her hip that hurt. Finally she blew up about it, and the intern did suggest that there were tests that would rule out the hip. Well, tests showed it WAS her hip, and she needed a replacement immediately before the damage got too bad. Moral is...ask for tests to rule out other issues.

And then there was my friend's autistic son who on a Friday was thrown against a wall by a therapist who didn't like his apology. The next morning he did some kid stuff and tried to stand on his head. And ended up with a horrible headache. Mom took him to the ER, they did a CAT scan and found he had a growth of fluid filled sacks in his brain. The previous day and morning events had nothing to do with it, but he now gets scans done periodically. It is not beyond chance that your partner might have something going on that was aggravated enough to bring on a few symptoms.

Yes, go in with her and ask for tests to rule out these kinds of things. Once ruled out, she may be either relieved enough to no longer have the symptoms, or be more willing to try what the doctors suggest. If things are as she thinks, it is better to know earlier than later.
posted by 101cats at 10:00 PM on September 8, 2014 [1 favorite]

Best answer: Sometimes the way people describe problems can unfortunately start their workup off on the wrong foot with a physician. It's not necessarily a sexism thing, it can be just due to the way some people tend to describe their problems in a vague way, or make blanket statements without giving relevant details. I find that this can happen more and more as people get frustrated with their medical care, because as they get interviewed by a subsequent doctor, they may be reflecting a lot of frustration with prior doctors and just be understandably frustrated by the whole process, which makes them harder to start a therapeutic relationship with, especially given how short most doctor appointments have to be these days.

Tips for communication:
- When describing the problem ("giving the history"), summarize: course, onset, duration, intensity, and exacerbating and remitting factors of the symptoms, as well as associated symptoms. For pain, also include quality, radiation, and severity. A great capsule summary would be something like "I came to see you because of a headache I've been having intermittently for the past 2 years. I get it every couple of months, and it's moderate to severe for a few days each time that I have it. The headache is pressurelike and located on the top of my head - it doesn't radiate down into my neck or other parts of my head, it's about an 8 out of 10 in severity. I usually use Tylenol and ibuprofen but they don't seem to change the pain at all. Lying in a dark room makes the headache better. Standing up makes the headache worse, and it's worse first thing in the morning. I also get associated lightheadedness with the headache (or specify vertigo if the dizziness is vertigo), and sensitivity to light and loud noises, but no vision changes, nausea, numbness or tingling." Note: this is obviously just an example I made up. If you get a summary like that out in the first minute of the appointment, your doctor is likely going to be really excited about what a great historian you are and how they can now spend so much more time talking to you about the plan.

Instead of "I've been to see a lot of doctors and nothing has worked." (vague blanket statement, sounds defeated/possibly accusatory and is hard to respond to)
Consider "I've been to see several doctors, I've tried over the counter medications, and X, Y, and Z [anything else she has tried]. Unfortunately, those things haven't helped." (giving specific history, providing a lead-in for what the physician could suggest next)

Instead of "I am really scared something is seriously wrong with me but everyone just thinks I'm crazy." or "I know something is wrong but I can't explain it." (vague/blanket statements, the former also sounding possibly accusatory)
Consider "I'm frustrated and worried that the problem hasn't been identified, because I haven't had any workup beyond a history and physical, and I continue to have debilitating symptoms on a regular basis." (provides useful context of past workup and statement of current situation)

Instead of "I'm constantly thinking about whether this might be cancer/some other life threatening diagnosis and it hasn't been detected." (speculation about rare diagnosis makes patient sound overly anxious, even though this is a perfectly human response, really). Sometimes people can make this worse by asking for things like a full body scan or other specific testing for the rare diagnosis off the bat, or bringing up stuff they found by Googling that actually doesn't make sense from a medical professional perspective, i.e. "I googled this and headache is a symptom of lupus/lymphoma/stroke/chronic fatigue syndrome, etc!"
Consider "When I get these symptoms, it really impacts my life because I can't go to work/can't do my regular daily activities/have excruciating pain [fill in the blanks with significant and specific ways in which the problem is affecting your life]." Instead of making it sound like worrying is what's impacting your life so much, this identifies concrete ways in which the physical symptoms are preventing you from doing what you need to do and gives an opening for the doctor to address how they can help you address the problems you're asking for their help with, instead of putting them on the defensive to explain why they're not looking for cancer or doing other esoteric tests.

Just some random thoughts that I hope may be helpful.
To address your follow up, I don't think you should tell someone, even gently, that they're being unreasonable unless you want them to get defensive. Find a way to frame what you're trying to tell her that comes from a place of caring and support, rather than sounding like an accusation, i.e. "It really makes me sad that you're still struggling with these symptoms. That must be so frustrating and hard for you. What do you think about having me come with you to your appointments so that I can support you better?" or "I was thinking about it and maybe the simplest way to continue to work through this problem would be to try what the doctor is recommending for a a few weeks, then go back to them if it's not working and make sure we press them on what the next step is. The most important thing to me is for you to feel better, and trying to work together with the doctor as a team to get this figured out might be the best way to continue to move forward in getting a diagnosis. It's your choice whether you want to try what they're recommending, but if you think it's worth a shot to try to help solve this problem, I'm here to help."

I really doubt this has anything to do with your partner's problems, but it doesn't sound clear to me that she couldn't have had a concussion from the blow to the head (she may have, she may not have). Pupil dilation is not related to the diagnosis of concussion. Typically, concussion is more likely in head injuries accompanied by a loss of consciousness, even a brief one, but not always. That being said, the headaches and dizziness that are part of a post-concussion syndrome generally last weeks to months - at the 2 year mark, it would definitely be unusual for this to be the cause of her symptoms, and she should be pressing for further evaluation.
posted by treehorn+bunny at 1:48 PM on September 9, 2014 [7 favorites]

Suggest therapy to deal with the stress of having this unresolved problem and let the therapist deal with telling her she's unreasonable/anxious (if that is, in fact, the case, which it might not be)
posted by the young rope-rider at 4:45 PM on September 9, 2014

Response by poster: Small update: I talked with MC about the answers so far and she was quite interested and amenable to the suggestions. Not totally sure about the therapy, but I think it's something we will get to pretty soon, and in the meantime we've got some great strategies for the next Dr visit.

Thank you to everyone who took the time to offer your insights and suggestions!
posted by Doleful Creature at 10:56 AM on September 10, 2014

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