A Letter to Patients with Chronic Disease – Dr. Rob Lamberts

A very interesting post written by Dr. Rob Lamberts in his blog Musings of a distractible mind, which has generated a lot of discussion around the web, as well as personal and touching stories shared by readers in comments.

A must read for anyone suffering from chronic illness.

Dear Patients: You have it very hard, much harder than most people understand.  Having sat for 16 years listening to the stories, seeing the tiredness in your eyes, hearing you try to describe the indescribable, I have come to understand that I too can’t understand what your lives are like.  How do you answer the question, “how do you feel?” when you’ve forgotten what “normal” feels like?  How do you deal with all of the people who think you are exaggerating your pain, your emotions, your fatigue?  How do you decide when to believe them or when to trust your own body?  How do you cope with living a life that won’t let you forget about your frailty, your limits, your mortality?

I can’t imagine.

But I do bring something to the table that you may not know.  I do have information that you can’t really understand because of your unique perspective, your battered world.  There is something that you need to understand that, while it won’t undo your pain, make your fatigue go away, or lift your emotions, it will help you.  It’s information without which you bring yourself more pain than you need suffer; it’s a truth that is a key to getting the help you need much easier than you have in the past.  It may not seem important, but trust me, it is.

You scare doctors.

No, I am not talking about the fear of disease, pain, or death.  I am not talking about doctors being afraid of the limits of their knowledge.  I am talking about your understanding of a fact that everyone else seems to miss, a fact that many doctors hide from: we are normal, fallible people who happen to doctor for a job.  We are not special.  In fact, many of us are very insecure, wanting to feel the affirmation of people who get better, hearing the praise of those we help.  We want to cure disease, to save lives, to be the helping hand, the right person in the right place at the right time.

But chronic unsolvable disease stands square in our way.  You don’t get better, and it makes many of us frustrated, and it makes some of us mad at you.  We don’t want to face things we can’t fix because it shows our limits.  We want the miraculous, and you deny us that chance.

And since this is the perspective you have when you see doctors, your view of them is quite different.  You see us getting frustrated.  You see us when we feel like giving up.  When we take care of you, we have to leave behind the illusion of control, of power over disease.  We get angry, feel insecure, and want to move on to a patient who we can fix, save, or impress.  You are the rock that proves how easily the ship can be sunk.  So your view of doctors is quite different.

Then there is the fact that you also possess something that is usually our domain: knowledge.  You know more about your disease than many of us do – most of us do.  Your MS, rheumatoid arthritis, end-stage kidney disease, Cushing’s disease, bipolar disorder, chronic pain disorder, brittle diabetes, or disabling psychiatric disorder – your defining pain –  is something most of us don’t regularly encounter.  It’s something most of us try to avoid.  So you possess deep understanding of something that many doctors don’t possess.  Even doctors who specialize in your disorder don’t share the kind of knowledge you can only get through living with a disease.  It’s like a parent’s knowledge of their child versus that of a pediatrician.  They may have breadth of knowledge, but you have depth of knowledge that no doctor can possess.

So when you approach a doctor – especially one you’ve never met before – you come with a knowledge of your disease that they don’t have, and a knowledge of the doctor’s limitations that few other patients have.  You see why you scare doctors?  It’s not your fault that you do, but ignoring this fact will limit the help you can only get from them.  I know this because, just like you know your disease better than any doctor, I know what being a doctor feels like more than any patient could ever understand.  You encounter doctors intermittently (more than you wish, perhaps); I live as a doctor continuously.

So let me be so bold as to give you advice on dealing with doctors.  There are some things you can do to make things easier, and others that can sabotage any hope of a good relationship:

  1. Don’t come on too strong – yes, you have to advocate for yourself, but remember that doctors are used to being in control.  All of the other patients come into the room with immediate respect, but your understanding has torn down the doctor-god illusion.  That’s a good thing in the long-run, but few doctors want to be greeted with that reality from the start.  Your goal with any doctor is to build a partnership of trust that goes both ways, and coming on too strong at the start can hurt your chances of ever having that.
  2. Show respect – I say this one carefully, because there are certainly some doctors who don’t treat patients with respect – especially ones like you with chronic disease.  These doctors should be avoided.  But most of us are not like that; we really want to help people and try to treat them well.  But we have worked very hard to earn our position; it was not bestowed by fiat or family tree.  Just as you want to be listened to, so do we.
  3. Keep your eggs in only a few baskets – find a good primary care doctor and a couple of specialists you trust.  Don’t expect a new doctor to figure things out quickly.  It takes me years of repeated visits to really understand many of my chronic disease patients.  The best care happens when a doctor understands the patient and the patient understands the doctor.  This can only happen over time.  Heck, I struggle even seeing the chronically sick patients for other doctors in my practice.  There is something very powerful in having understanding built over time.
  4. Use the ER only when absolutely needed – Emergency room physicians will always struggle with you.  Just expect that.  Their job is to decide if you need to be hospitalized, if you need emergency treatment, or if you can go home.  They might not fix your pain, and certainly won’t try to fully understand you.  That’s not their job.  They went into their specialty to fix problems quickly and move on, not manage chronic disease.  The same goes for any doctor you see for a short time: they will try to get done with you as quickly as possible.
  5. Don’t avoid doctors – one of the most frustrating things for me is when a complicated patient comes in after a long absence with a huge list of problems they want me to address.  I can’t work that way, and I don’t think many doctors can.  Each visit should address only a few problems at a time, otherwise things get confused and more mistakes are made.  It’s OK to keep a list of your own problems so things don’t get left out – I actually like getting those lists, as long as people don’t expect me to handle all of the problems.  It helps me to prioritize with them.
  6. Don’t put up with the jerks – unless you have no choice (in the ER, for example), you should keep looking until you find the right doctor(s) for you.  Some docs are not cut out for chronic disease, while some of us like the long-term relationship.  Don’t feel you have to put up with docs who don’t listen or minimize your problems.  At the minimum, you should be able to find a doctor who doesn’t totally suck.
  7. Forgive us – Sometimes I forget about important things in my patients’ lives.  Sometimes I don’t know you’ve had surgery or that your sister comes to see me as well.  Sometimes I avoid people because I don’t want to admit my limitations.  Be patient with me – I usually know when I’ve messed up, and if you know me well I don’t mind being reminded.  Well, maybe I mind it a little.

You know better than anyone that we docs are just people – with all the stupidity, inconsistency, and fallibility that goes with that – who happen to doctor for a living.  I hope this helps, and I really hope you get the help you need.  It does suck that you have your problem; I just hope this perhaps decreases that suckishness a little bit.

Sincerely,

Dr. Rob

My view on the post: I did not find anything new to add to what I already know or have understood about doctors in the context of treating patients with chronic illness. But I found it refreshingly honest and brave of a doctor to write the post and I think it may help many people with chronic illness to read this perspective. I also think, in the end, it does not really change the situation of a person like me who has limited access to specialists and certainly does not have the opportunity to change doctors.

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About Hypermobility Syndrome India/Viv

I an an Indian woman with Ehlers Danlos Syndrome Hypermobility Type (EDS-HT), also known as joint hypermobility syndrome. Although I have "suffered" from this disease all my life, I was diagnosed at 38 years, 2 years after my child was born. My work mainly involves being a mom to my beautiful and compassionate child. I also write and work from home in the field of science. I aim to raise awareness about EDS-HT, chronic pain, invisible illnesses, mental illnesses and invisible disabilities through my blogs. Viv (Latin root, meaning Life/ Alive) is my blogging pseudonym and alludes to my continued endeavor to rediscover my life and its meaning.
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6 Responses to A Letter to Patients with Chronic Disease – Dr. Rob Lamberts

  1. ravenwing72 says:

    Reblogged this on In my own little world and commented:
    A letter to patients with chronic illness…

    Like

  2. Reblogged this on Mom's Chronic Ride and commented:
    A Letter to Patients with Chronic Disease – Dr. Rob Lamberts | Why aren’t medical school’s teaching a class on Dr./Patient relationships?

    Liked by 1 person

  3. This is a wonderful letter thank you so much for writing it. I needed to hear this because my primary doctor over the last 15 years was killed three weeks ago and I am terrified to have to find a new doctor and re-educated them about my chronic illness. The last specialist she had sent me to listen to my request and immediately attacked me all because I had asked him a question he obviously did not know the answer to. I said I was in his office because I have had a lot of rare side effects of chron’s disease and the one I needed information about was an inflamatory arthritris that occured with and without a flareup of the disease. He immediately looked up and said it was obvious I had not had a flare up because I was quite fat I explined that I was on lyrica and the leading side effect of that drug was weight gain. Than he said he had never heard of lyrica causing any weight gain and as far as he was concerned is all I had was irritable bowel disease and that I did not have Chron;s disease. I wondered how he jumped to that conclusion since I had three bowel blockages and a bowel resection that resulted with most of my small intestine being cut out and also needed a blood transfusion because I had bled in small amounts over many years . In fact I was even more puzzled with his snap diagnosis seeing as he had never examined me. He than threw a signed form my way and said if you think your so sick goahead and have a colonoscopy and maybe it will convince you. He said all this all just because I asked him a straight forward question. Up untill reading this post I had no idea why he acted the way he did but now I do he obviously had no experience with a chron’s patient who had or wanted information on inflamatory arthritis that occured because of a flare up of Chron’s disease. It was not my intention to intimadate him but obviously I did. I will be taking your suggestion as I long for a doctor. Thanks so much for allowing me to see a negitive interaction from another perspective

    Like

    • I am horrified to read the ordeal that you went through in this consultation, but sadly, I can relate to it very well. Unfortunately, along with having to deal with the disappointments that result from the disease, one must also deal with the dismissiveness of doctors. It is a different thing that a disease is supposed to hurt and a doctor is supposed to heal. It would be nice for this letter to be published in a medical journal – because while it is gracious of us to understand their failings, they must also introspect to understand where they fail.

      Like

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