Doctors of all kinds

This chapter is something I have learned through trial and error. I am chronically ill, so since I was 18, I have explored most fields of medicine.

American healthcare is set up as a marketplace; the goal of market health care is to incentivize innovation and education. The more trained and successful doctors are making more, in theory.

However, it has led to healthcare being inaccessible, unaffordable, and sometimes outright hostile. Doctors go through specialized training to become authorities on our own bodies (basically setting laws on our own existence sometimes). How to interact with doctors and American health care professionals is a skill often not taught but learned.

Like everything else, being informed is a way of protecting yourself against medical manipulation, overcharging, and misinformation. Let’s walk through health care together.

To start, you are going to need to establish a primary care medical professional. I say medical professional because your primary care can in fact be a nurse practitioner instead of a doctor. Your primary care is who you go to for health checkups and who you call up when you get the flu.

I would do a yearly check-up with your primary care provider, where you can discuss concerns and issues that pop up. When you are setting this appointment, make sure to pick a time where you can block out 2 hours of your schedule. Even if you think it will be a quick and easy appointment, it is better to give yourself extra time rather than feel rushed.

At your first appointment with your primary care provider, they will ask about your family medical history. I suggest writing it all down beforehand. Make a list of every known diagnosis for cousins, siblings, grandparents, aunts/uncles, and parents.

You will need this list in the future for other appointments, so call up your family gossip and ask questions. You don’t have to tell the primary care everything if it becomes a long list (my grandma was one of 12 kids, so my list gets long fast), maybe highlight the more serious health issues.

The next questions are going to be about you. What medicines do you take? Are you allergic to anything? Have you previously been diagnosed with anything? Answer honestly, some medications have bad interactions with each other. Also, some health issues from your childhood can be a sign of other things later. The point of this first appointment is to make sure your primary care has everything important written down in their files.

If there are any issues you want to discuss, do so. I recommend asking for a basic blood panel to check on your vitamin, mineral, and nutrient levels. Even in your 20s you can suffer from low or high levels of random things. Getting a blood panel is a way to figure out if you need to keep your eye on anything before it becomes a problem.

Your primary care can refer you to other doctors if serious issues pop up or there are specialized concerns you have. If you get a referral, it means that your primary care is sending a message to another doctor saying, “will you see them for x reasons?” Then, in theory, that doctor’s office will call you to schedule an appointment. Sadly, most of the time this doesn’t happen because that office is busy with their preexisting patients. Instead, you can call them to schedule that appointment.

Save the name, address, and phone number of your primary care and keep it somewhere easy to access. Every doctor you see will want to know who your primary care is. In some cases, like university students who attend universities far from home, you can establish 2 primary care providers. This even includes doctors your primary care sends you to.

For healthy individuals, this is the end of their interactions with the medical world. Which is great, congratulations! For people who get injured or suffer something diagnosable, things get complicated after this point.

It is with a heavy heart that I inform all of you that medical professionals of all kinds do in fact make mistakes and judge you. They are not infallible truth speakers who see into your very soul and heal you with some kind of gifted healing magic. Doctors are people, they have religious beliefs, lives, and opinions that impact how they treat their patients.

This means that if you are a person of color, a woman, a queer individual, or some other demographic that is treated poorly, you risk being mistreated or misunderstood by medical professionals.

The most egregious disrespect will be obvious; doctors will dismiss your symptoms or even say you are just too anxious. If a doctor dismisses you by saying you are just stressed, anxious, hormonal, or not sleeping enough it’s an indicator that they are not the right doctor for you. Even if you are experiencing symptoms due to stress, anxiety, hormones, or a lack of sleep, those are all treatable conditions.

Some people try sticking it out with doctors who do not listen to them by forcing their hands. One proven method is if you have a doctor refusing to do a test on you, you can request they note in your medical chart their refusal to do the test. Writing on paper that a test is being avoided is a more drastic action than just saying no to your request. Even if this doesn’t make your doctor do the test you wanted, it can still help you get the next doctor to do the test you need.

Another trick is if you are seeking help for specific conditions, for example depression, and your doctor denies you have it, you can request a differential explaining their thinking. A differential is when a doctor lists out common symptoms of a condition and compares them to your symptoms. Making your doctor go through the differential out loud gives you the chance to provide more information if they seem to be missing something.

I will warn you, often doctors are very defensive over their intelligence. Either of these tricks can make a doctor feel like you don’t respect their authority. I personally have made many doctors dislike me because I question their reasoning.

The way doctors seem offended by any challenge to their authority is understandable and natural, but I refuse to tolerate being talked down to about what is happening in my own body. There is a line, a doctor telling me I am imagining symptoms or just need to sleep more is absolutely infuriating and inappropriate. A doctor telling me that my blood work shoes low levels of Vitamin C and I need to try incorporating more fresh fruits in my diet is acceptable and helpful.

Some slights are not even intentional in the medical community. In America, doctors use something called the BMI to determine if patients are at a healthy body mass (weight). The BMI is a very harmful baseline measurement because it is a system based on white European men. If you are told you are overweight according to your BMI, it is typically because you are not in fact, a white European male. Fun fact: different body types have different healthy weights and densities.

There is also less research into women and people of color. This is mostly because it only became legal to research women and people of color in the 1980s and 1990s. It only became required to include different demographics in research in 1993. Racism and sexism both impact a lot of what medical experts have discovered about the human body.

Women have faced serious restrictions on health care. They also will have things written on their medical charts like “this just happens to women” and “hysterical.”

My younger sister was rushed to the emergency room as a 16-year-old because a cyst ruptured on her ovary, causing her to almost pass out from pain. The only thing that ended up giving her relief was a morphine drip while doctors did tests. When they realized it had been a cyst rupturing, they unhooked the morphine, wrote on her chart “common occurrence for women,” and sent her home with instructions to take Tylenol. My sister told me it was the worst pain she had ever experienced, and that girl has fallen off horses and out of trees.

People of color are likely to suffer racism even in diagnostic criteria. It is well known that things like autism, anxiety, depression, and personality disorders can greatly impact a person’s enjoyment of life. They also all can have very different symptoms, so when someone does not present in the same way as say a white person would, they are dismissed.

I am not writing this to discourage you or to make you hate all doctors. I just want to prepare you, be on the lookout for situations where you feel uncomfortable or ignored. Get a second opinion or even a third and fourth if you need to.

The best practices for talking to doctors can vary, sometimes a tactic works better for women rather than men. I can’t guarantee any of these are going to make your doctor suddenly the best medical professional out there, but they will help you be a better patient.

The first is to take someone with you if possible. Doctors are more likely to believe you when you are confident and if there is someone else in the room. Bring a friend or family member along to just sit there and zone out, they don’t even have to pay much attention. Their mere presence is going to make that appointment less private, putting less stress on you the patient and more accountability on the doctor.

The second thing you can do is be honest. I know it feels weird to answer personal questions about yourself, and they do get very personal, but if you are honest that doctor has a better idea of what is happening in your body. Some of the questions they ask may cover illegal substance use, a doctor cannot legally disclose your use of substances unless it is harming someone. Just be honest, it will speed up the process of treating you.

Third, tell your doctor your concerns. If you are worried about adding a new medication to your list, tell them. If you don’t love the idea of surgery, say so. This also goes into boundary making, some injuries are going to have multiple solutions from invasive (surgeries) to noninvasive (physical therapy). If you tell your doctor you want to avoid surgery, then they can help you understand what other steps you can take or why you need surgery.

Fourth, don’t be afraid to research. I mean more research than a simple look at WebMD, doctors are not huge fans of patients quoting WebMD or self-diagnosing. Instead, you can look for more sources, including research papers or first-person accounts. Sometimes it helps if you phrase it as a question, like “I have seen some first-person accounts of others who has similar symptoms, their doctors diagnosed them with insert disease here?” If you get shut down, this is when to pull out the “can you explain why you don’t think this is the case? Give me a differential maybe?” The research should be revisited after your appointment. You may have new topics to research too.

Last tip to being better at communicating with doctors is to take notes. Or keep notes. Collect the after-visit summaries from your visits and write down your own version of things. Save all those visit summaries in one place. Save your test results too. This is a way to build your own medical history for future doctors’ appointments.

I also want to explain some common things you may come across at a doctor’s office.

A co-pay is what you pay out of pocket for an appointment. It is lowered by insurance.

While I don’t have the time or capacity to explain the insane practices of American health insurance, I can tell you that your insurance rates are based on your medical history. The more medical issues you have on paper, the more your insurance is going to cost you.

Not every diagnosis is helpful. Being diagnosed with something like autism is great when you are a kid because you can get accommodation at school or even university, but most workplaces don’t acknowledge autism as a disability. In that circumstance depression, anxiety, or ADHD diagnoses are more specific and beneficial. And medically speaking, autism has changed meanings a lot, it is an umbrella diagnosis for anyone who has a differently functioning brain. I am not saying an autism diagnosis is bad, I encourage people to get tested, but it is not always life changing.

Everything in your body is connected. Doctors don’t always acknowledge this, but if you have rampant insomnia and are struggling to maintain a healthy body weight, those two things can be impacting each other. Try treating all the symptoms, even the ones that feel wildly out of place. It does help.

Tylenol and Ibuprofen are different. Both relieve pain, but the chemical compounds are different. Tylenol is considered milder because it only treats pain. If you have chronic headaches or pain, consider Tylenol first because long term use has less impact on your body. Ibuprofen relieves pain while lessening inflammation and fevers. This medication is harder on your body if used often. It can eat away at your stomach lining and in cases of chronic headaches, Ibuprofen has been proven to start triggering headaches over time.

Opioids are a very powerful pain relief that can only be prescribed by a medical professional. They can be highly addictive, so always try for the lowest dosage if you do need to take one. Also, never EVER share your prescription opioids with others. Opioid addictions are some of the most deadly and hard to break, often opioid users become heroin users. You can safely use an opioid if you follow your doctors instructions and stop taking them as soon as possible.

There are lots of medical tests you can have done. It is important you know what those tests are and what they show. X-rays are most common for injuries, but they are not foolproof. They can miss things or even be read wrong. Some fractures or breaks in bone don’t show well in X-rays or a small measurement may seem insubstantial but end up being a big deal. Doctors want X-rays for insurance purposes even in circumstances where an X-ray is not helpful.

Other tests that might follow an X-ray for a better look at an area can be MRIs, CT scans, and even ultrasounds. (Ultrasounds are not only to look at fetuses.) Do research on any of these tests if they come up but good rule of thumb is a MRI uses magnets to see the internal structures of the body, a CT scan uses X-ray technology on a more 3-dimensional scale, and an ultrasound shows internal structures on a small-scale using sound waves.

If you get your blood tested for nutrients, vitamins, or other levels of strangely named substances, be sure to research the actual average levels. Doctors’ offices often use much larger ranges to accommodate for everyone, which means if you have a level that they say is average it can still be low for your body type.

I will add on a quick chart for you on the difference between doctors, nurses, and nurse practitioners. The big thing to know is bedside manner changes depending on which, nurses and nurse practitioners are more likely to have a better bedside manner.

I hope that my knowledge of the American health care landscape helps you. This all comes from years of visiting doctors of every kind. I wish only the kindest doctors and nurses for you; may they all have open minds and keep up to date on new medical research.