Take Us Seriously

10 Reasons Doctors Don’t Take Undiagnosed Patients Seriously

Ellen Berry on 05 10, 2009

Getting doctors to take a health problem seriously can be one of the most significant hurdles undiagnosed patients face.  This is because primary care, specialty and emergency room physicians have their own hurdles to clear before they can truly hear what a patient is saying — and do the necessary amount of digging to find the true cause of an ongoing undiagnosed condition. Here are 10 reasons a doctor may dismiss your symptoms… or you.

For suggestions on how to proactively address these obstacles and increase the chances of proper diagnosis and treatment, read “How to Get Your Doctor to Take Your Undiagnosed Condition Seriously.”

1. Think horses, not zebras. Doctors are trained and conditioned to look for the most common explanation, not the unusual one, because for the most part they deal in mainstream conditions that are reasonable easy to diagnose. In medical school they are taught “If you hear hoof beats in the park, think horses, not zebras.”This is generally good advice, since most of us who come in with a stomach ache or high blood pressure expect our doctors to treat the condition in a straightforward manner, not leading us down a rabbit hole of possible diagnoses. But when common symptoms mask a underlying problem that is unusual, this way of thinking can be just as dangerous as it can be efficient.
2. By the book. There are established protocols or “recipes” for many conditions that instruct doctors on step-by-step procedures for identifying, diagnosing and treating. If a patient’s symptoms don’t match a protocol he or she is familiar with, the physician will be inclined to “turf” or refer a patient to another doctor who is more likely to be familiar with the protocol.
3. Professional courtesy. There are invisible lines between doctors that they are taught not to cross.  If a specialist such as a nephrologist (kidneys) or endocrinologist (hormones) tried to treat your aching joints or a heart problem, he or she would be stepping on the toes of a rheumatologist or cardiologist…and they would be trying to practice in an area for which they haven’t received formal training. The referral system is in place to help prevent this and extend professional courtesy. Coming in to see a new doctor because a doctor in their group referred you means you’re more likely to be taken seriously, because you’re participating in the local physician’s buddy system. This can be a problem if you choose a specialist based on Internet ratings or word of mouth and walk in “off the street”. If you are “doctor shopping”, and while under the care of one practitioner you decide to go to another practitioner of the same kind and expect them to work together, this is a likely way to have one or both of them fire you as a patient.
4. Revolving door. To stay in business, physicians have to keep the door revolving to appease health insurance companies and pay their employers or their own bills. So they allot a certain amount of time which includes the actual appointment, but also answering the phone, filling prescriptions, and other tasks related to an individual patient. Therefore, allowing medical curiosity to inspire researching potential diagnoses or creative problem solving, in their mind, detracts from time that could be provided other patients. Taking patients seriously takes more time.
5. Clear communication. A language barrier exists between most patients and doctors. A physician’s effectiveness is dependent on how well the patient communicates with them, describing symptoms using words that mean the same to both doctor and patient. For example, a headache could be described as stabbing, dull, throbbing, pressure, tightness, burning, tingling or radiating. But if a patient has never experienced throbbing pain, they would not be able to confirm for the doctor if that word describes their pain.
6. Shooting in the dark. Lack of pertinent information forces doctors to work in a vacuum. If patients provide limited or incorrect information about patient medical history, family medical history or current symptoms because they don’t know, don’t remember correctly, are embarrassed, or haven’t recognized a problem they’ve been living with (such as snoring) as a related health problem (sleep apnea), a physician is challenged to make a correct diagnosis.
7. Self preservation. Manipulative patients who are trying to get the doctor to do something for them such as prescribe medication, diagnose an uninsured friend by reporting the friend’s symptoms as their own, etc. do genuinely undiagnosed patients and their doctors a major disservice. Other patients may want a doctor to “fix” them without having to do anything themselves such as changing their diets or taking medications when appropriately prescribed. Such abusive and uncooperative patients can burn a doctor enough that they avoid any case that looks like it’s gone nowhere before.
8. Limited liability. Some doctors avoid making a diagnosis because of the increased liability and cost to their practice in regards to health insurance. They selectively choose patients they can treat with ease. Others are unwilling to run tests because they don’t feel comfortable interpreting the results. Or they avoid following up on tests requested by other doctors because they don’t understand the context in which the tests were requested, and don’t want to be accountable for decisions made by others.
9. Too much work. Sorting out overlapping conditions, an unusual combination of symptoms or complex cases can be intimidating to any medical practitioner. If you have a thick medical file, or a long list of previous doctors, a doctor may think “if other doctors haven’t been able to help her, I probably won’t be able to either”. This is especially true if the doctors you’ve seen are at respected medical facilities like Mayo, Shands, Cleveland Clinic, Johns Hopkins or Cedars Sinai. Or, the doctor may be simply stumped and unwilling to do the necessary research or confer with other doctors.
10. Head cases. Some doctors consider specific diagnoses to be red flags to warn them that patients may have mental problems or represent other kinds of “trouble”. (Fibromyalgia has had this stigma in the past, but is now receiving increased validation from the medical community as a “real” syndrome). The relationship between thoughts, emotions and physical ailments is real and tangible. A perfect example is thinking of someone close to you who died… The thought creates sadness, which leads to tears. Thoughts can be so powerful as to give a woman who isn’t pregnant all the symptoms of pregnancy. Doctors witness the power of thoughts and feelings on our bodies every day. If medical tests come back negative, or symptoms are not visible or reproduceable during the appointment, they can’t rule out the role our heads and hearts play in our health. Their own belief and value systems contribute to the decisions they make about us and why we’re sick. They may look at us and identify real mental or emotional states that are contributing to our physical distress, or may interpret what we say and do inappropriately based on their own assumptions, and send us off thinking it’s all in our heads.

For suggestions on how to proactively address these obstacles and increase the chances of proper diagnosis and treatment, read “How to Get Your Doctor to Take Your Undiagnosed Condition Seriously.”