better self-advocacy for medical treatment
January 16, 2024 12:04 AM   Subscribe

I struggle to challenge medical practitioners when I feel like they're being flippant or dismissive of my concerns. How should I approach medical appointments and interactions for better outcomes for myself?

I made an appointment at my GP surgery recently after having multiple episodes of sharp, stabbing chest pain. Most recently, this pain hurt so much, I was lying on the floor, considering if it was a heart attack or not-but as soon as I thought to go to A&E, the pain went away, so I thought it could wait until a GP appointment. (In hindsight, I should have just gone to A&E but I didn't want to get there and be made to feel like I was making a big deal out of nothing.)

In my appointment, after describing my symptoms, the nurse practitioner who saw me said that: it could be trapped wind; there wasn't anything they could do for me if I wasn't currently expecting chest pain; and I was too young for a heart attack anyway. At the time, I was so stunned that I was being spoken to as if I'm not capable of differentiating between gas/wind and debilitating pain, that I just accepted this advice and left my appointment. It seemed odd to me that on the NHS website, the guidance for chest pain that has gone away is to seek medical advice from your GP, only for that advice to be, "There's nothing we can do until it's more urgent."

This is not the first time something like this has happened. I have a lengthy history of trying to get help for medical issues, only to be dismissed outright. As another example, I have period pain that is so severe, I can barely function for a couple of days. I lose enough blood that I can fill a menstrual cup in an hour. I was told (by a female GP!) that this is just how periods are and I was prescribed a NSAID and tranexamic acid, with no further investigation into why this is happening. Lacking the fortitude to challenge what the doctors tell me, I just accept that I have to live with symptoms like this.

I'm a soft-spoken, young-looking woman and I think it's incredibly easy for medical practitioners to be dismissive of my concerns as 'anxiety' or 'over-worrying". I feel that I might have better health outcomes if I were more able to constructively disagree with practitioners during my appointments.

What approaches have worked for you to better advocate for yourself at medical appointments?
posted by quadrant seasons to Health & Fitness (10 answers total) 10 users marked this as a favorite
Best answer: I am sorry that happened to you.

Have you seen this recent Metafilter post? Codewords to use on doctors and such
posted by hurdy gurdy girl at 12:48 AM on January 16 [4 favorites]

In addition to the advice in the post linked by hurdy gurdy girl, sometimes just finding a more sympathetic practitioner can help. I lived in the UK for a short period, and it was widely known in my area that some of the practitioners at my surgery were great and took patient concerns very seriously, while others were terrible and dismissive to the point of sending patients home with literal broken bones. After a few bad experiences with a certain doctor, I started directly telling the receptionist that I didn't want to be seen by Dr. Patient-Ignorer when I scheduled appointments, and I never got any pushback. Maybe you could ask around for advice on which doctors are better at your surgery.
posted by nanny's striped stocking at 12:53 AM on January 16 [2 favorites]

I have had better experiences with recently qualified GPs than with longer serving practitioners and I think that's because they are more conscious that they don't know everything. As suggested you can try and establish whether someone at your current GP practice is better than the rest.

My other suggestion is to try and find a practice at which you are closer to the demographic norm that the practice serves. For example, when I was younger I was registered at a university-associated practice for a long time and found them much more helpful to me than my previous GPs practice which had a much older demographic.
posted by plonkee at 5:21 AM on January 16 [3 favorites]

Statistical research shows that female GPs listen to patients for longer, and take longer to interrupt patients, so you could try seeing a female GP.

(I've certainly had my share of awful doctors of both genders!)
posted by chariot pulled by cassowaries at 5:26 AM on January 16

I am so sorry this happened to you. Please see if the post linked above about language/codewords to use in medical appointments is useful. Data point (IANYD, YMMV, etc.): When I felt stabbing pain just as you described, I hurt so badly I was sure it was a heart attack. Turns out it was a gall bladder attack. A gall bladder scan revealed gallstones and I had it removed laparoscopically soon after.
posted by I_Love_Bananas at 6:01 AM on January 16

Dr. Jerome Groopman wrote How Doctors Think, about how to improve diagnoses. For patients, he suggests asking five questions:

Ask What else could it be?, combating satisfaction of search bias and leading the doctor to consider a broader range of possibilities.
Ask Is there anything that doesn't fit?, combatting confirmation bias and again leading the doctor to think broadly.
Ask Is it possible I have more than one problem?, because multiple simultaneous disorders do exist and frequently cause confusing symptoms.
Tell what you are most worried about, opening discussion and leading either to reassurance (if the worry is unlikely) or careful analysis (if the worry is plausible).
Retell the story from the beginning
. Details that were omitted in the initial telling may be recalled, or different wording or the different context may make clues more salient.

It's difficult to do this with doctors who are not receptive to questions, but having a framework of questions might make it easier.
posted by Mr.Know-it-some at 7:00 AM on January 16 [20 favorites]

Best answer: I had HiDeOuS chest pain once while camping in the middle of nowhere in the south of France in like 1995 or 6. It woke me up from a dead sleep and I bolted upright, convinced it was a heart attack. My asshole boyfriend at the time laughed and said to go back to sleep, which obviously I couldn't do, since I was in agony. Finally it subsided. It never came back, thank goodness, and I never found out what caused it, but just the other day somewhere in my meanderings on this website I saw the suggestion that sometimes an out-of-nowhere esophageal spasm can cause intense chest pain. Maybe that was what it was? A long time ago I read something about migraine sometimes causing chest pain. Maybe it was that. Anyway, if I'd been somewhere where I could've more easily gotten myself to an emergency room, I'd've gone, and if I'd had a doctor at the time, I'd've made an appointment. It really hurt. If I'd done that, then maybe either somebody at the ER or somebody at the GP might have listed those possible causes and maybe even more possibilities along with the dismissive "har, you had gas!" If they're going to shrug and tell you to go away, they should at least provide you with a more comprehensive list of what could have caused your pain.

As for this: "I lose enough blood that I can fill a menstrual cup in an hour. I was told (by a female GP!) that this is just how periods are," I can relate. Everybody who did my pap smears handed me the "it feels like more but it's just a couple of teaspoons!" line of garbage from the back of the Tampax box. They were all women, and they all bought the ancient lore from the ancient and bad data Tampax got back in the 40s or whenever they did their ten minutes of research. When I finally got the menstrual cup it became clear that it felt like more than a couple of teaspoons because it was a whole lot more than that.

It's depressing, because, like, aren't people curious at ALL? It boggles the mind how somebody can take a biology class, get fascinated, then go through all the pre-med, med school, residency, the whole nine, and then something happens to them to douse the fire and we're left with a standard of care that's basically: "har, you had gas!" "It's just a couple of teaspoons every month, you're anemic because you're vegetarian, take these pills with orange juice or eat a steak."
posted by Don Pepino at 9:06 AM on January 16 [2 favorites]

Best answer: i am in the us and am not familiar with your system. but, if possible, find a new provider.

if that is not possible, do you have a male person in your life who you are comfortable having go with you? i have found that having my partner there, even if he says literally nothing, results in doctors spending a bit more time with me. my partner's very presence also makes me feel stronger, so i am able to ask more questions that i have, because i know that if i'm berated, his presence will make me feel okay about speaking up.

it should not be so hard to get quality medical care, but unfortunately it is.
posted by misanthropicsarah at 10:21 AM on January 16 [2 favorites]

I have the same problem and have tried a lot of different things without luck. Unfortunately what I found most effective was using Dr. Google to figure out exactly what tests or treatments I want to try myself and asking for them specifically. I'm sure some doctors will be annoyed by that, and it would also be a lot better if someone more knowledgeable than me were TRYING to help, but it's the only way I've gotten any help at all.
posted by metasarah at 2:02 PM on January 16

I use my Google calendar to track recurrent symptoms, being specific as to time of day and description of symptoms. Then I relay this to the doctor, often listing the dates/descriptions in a Word document that I have printed out and take with me.
posted by apartment dweller at 8:20 PM on January 16 [2 favorites]

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