- Here's a real story about a real patient of mine,
details obviously change to protect their privacy,
but it's about a woman's pain
that was consistently discounted
and blamed on her weight, on her gender, unfair reasons.
This case is also illuminating many of the problems
that exist within our healthcare system.
So I'm gonna leave you off with three actionable steps
that you can take to improve your healthcare relationship
with your doctor, let's get started.
Becky is a 58 year old female that has a good relationship
with the healthcare system, she has a primary doctor,
she has an urgent care center
near her home that she frequents,
and in general considers herself to be quite healthy.
Over the last few months,
Becky started experiencing more joint pains
and more fatigue, so Becky made an appointment
to see her primary care doctor.
In going in for the visit,
the primary care doctor asked some questions,
conducted a thorough physical exam, and came up with a plan.
But the plan followed the assessment,
and the assessment was that Becky,
being a 58 year old female,
was in her post-menopausal state,
meaning that she went through menopause,
is experiencing hormonal changes,
also happens to have a BMI of 29,
which puts her into the overweight category.
Therefore, the doctor's conclusion was,
Becky, being slightly overweight,
having this hormonal change due to being postmenopausal,
is experiencing these joint aches and fatigue due to that,
not an actual medical condition that can be treated
with a specific medication, surgery, or therapy.
So the doctor's recommendation was to lose weight,
to focus on herself, to do some reading,
meditation, mindfulness, all things that I think
most people would see as positive in general.
So Becky, being a good patient, went home,
started this plan, tried to motivate herself
to lose a few pounds, to take some time away from work
and go on walks, it wasn't until two weeks
after that initial visit when Becky woke up
and she could barely get out of bed.
She was experiencing excruciating pain in her shoulders,
in her biceps, in her hips, in her low back.
It was so debilitating that she did not wanna get out of bed
and even go to work.
For a person to experience that level of pain
and discomfort, it was worrying to her.
In fact, Becky's husband urged her to call 911 and said,
"Maybe you're having a stroke."
But Becky said, "You know what?
Let's call our doctor and see what's available."
Doctor says they're unavailable for today,
but recommends that she head onto her local urgent care.
So Becky goes to her local urgent care center,
they take a thorough history, they perform a physical,
and they don't quite know what's going on.
So they order a bunch of blood work,
and Becky is not privy to what blood work was ordered,
but they told her to take some anti-inflammatories
in the meantime until they get the results
of that blood work.
So they gave her a Toradol injection,
which is a non-steroidal anti-inflammatory medication,
similar to ibuprofen or naproxen,
but because it's given intramuscularly,
it works a little bit quicker,
patients feel like it's a little bit more
of a potent medication.
So Becky got this injection, she felt a little bit better,
she went home, even though she was still in pain,
she wanted to be a good patient,
plus she had the little voice in her ear
of the previous doctor saying,
this could be related to your weight.
She didn't lose the weight that she thought she could,
she didn't follow all the mindfulness practices
that she set out to, and she started blaming herself,
which unfortunately a lot of patients do
in situations like this.
Three short days later, she receives a call
from the urgent care and they tell her
that her blood work has come back,
and they found that her inflammatory markers were elevated.
ESR and CRP, these are non-specific inflammatory markers.
So by testing them, we don't make a diagnosis
of any specific condition.
For us as doctors, if we see that,
we start feeling a suspicion of an autoimmune condition
where their own body attacks itself,
or perhaps a cancerous process,
or even an infectious process in some cases.
She was very worried about this potential diagnosis,
she did have some family history of cancer.
And when Becky came in, they told her that, look,
they aren't sure exactly what's going on,
but they believe that given her joint pain
was still there that she would benefit
from a seven day course of prednisone,
which is a steroid that is targeting
the inflammation within the body.
So they gave her a seven day course of prednisone.
She went home, started taking it, and what do you know?
The next morning she wakes up, feels like a million bucks.
She thinks it's solved, she feels great,
day two, feels great, day three, feels great,
and so on it goes the rest of the week, she's very happy,
and she thinks her problem has been solved.
But then comes day 10 when she's now three days
without the steroid and the pain comes back.
So Becky, trying to be a good patient,
calls the urgent care, makes an appointment.
They see her and they explain that
they're not sure what's going on and that they'd like
for her to see a rheumatologist, which is a specialist
in joint health and autoimmune diseases,
and they give her a referral.
Becky, again, good patient, goes home, instantly calls,
tries to make an appointment, and given this is March, 2023,
they give her an appointment for December, 2023.
9 months, so Becky is sitting there in tears,
wondering why she has to wait nine months
while she's in pain, not able to perform life duties,
take care of her home, her family, go to work,
and just be even somewhat pain free.
So she starts panicking, she starts getting really worried,
and she understands that she has to do something else.
This is where Becky comes into my office.
I saw a very concerned patient,
a patient that was given the runaround,
no explanation for blood test results,
I got a sense that she was probably treated
unfairly given the fact that she was carrying
some extra weight and the fact that she was postmenopausal.
And I have to make a note here,
that if a doctor says it would be helpful
for you to lose weight because your joints
are experiencing a heavier burden
than if you were to lose weight,
that is good advice in many instances,
but if they are just jumping to that conclusion
without fully examining you,
fully understanding what's wrong with you,
doing a thorough evaluation, then they may be giving you
a misdiagnosis simply due to laziness.
I needed to make sure and do the due diligence
and check, were the correct blood tests ordered?
Were they correctly interpreted?
Because honestly, when you're going to an urgent care
and you're having multiple doctors take a look at you
and there's no continuity, it's very easy for things to slip
between the cracks, for things to not get explained,
or to even get thoroughly logged.
So I requested all the previous lab work that was done
in all of these visits, and I found that
it was in fact high inflammatory markers,
the ESR and CRP were elevated.
Something else that was interestingly elevated
was something called ANA testing,
which is anti-nuclear antibody testing
that we do to come to a diagnosis
of an autoimmune condition.
But ANA testing on its own is not definitive,
it doesn't help us understand
what autoimmune condition is present.
So I needed to really start from scratch
and reorder almost all of the lab work,
with the exception of things that they've definitely tested,
and figure out what exactly is going on.
So I reordered all this lab work,
I explained to her that she's no longer
gonna get the runaround, I'm gonna be on top of this.
I did all of the labs, and what did I find out?
It was Lupus, it wasn't because she was postmenopausal,
having hormonal changes,
it wasn't 'cause she was slightly overweight
and carrying that burden on her joints,
these were misdiagnoses.
And Lupus was a missed diagnosis,
not just her inflammatory markers, not just her ANA,
but other tests that really signify
that a patient is experiencing Lupus
we're also elevated, like the double stranded DNA antibody.
There's actually a scoring system that we use
from the American College of Rheumatology
that gives scores to certain symptoms
that a patient is having plus points
for having certain tests flagged positive on their results.
And when I added up her points,
she fell into the category of definitive positive for Lupus.
I decided to get her a rheumatology appointment as well.
She calls, gets an appointment for January, 2024,
these wait times are just astronomical.
So I called the office and I explained the patient's pain,
her situation, the fact that she's in fear
that she's gonna be in pain for the rest of her life,
and were able to speed up her appointment
to just a week and a half, two weeks time.
I called her back, I explained everything that was going on,
why I was ordering certain tests,
what the results showed me, why I wanted the rheumatologist,
the patient was very grateful.
Just that conversation lowered her pain.
And that's not a placebo effect,
this is a human survival effect,
because when we are nervous, we are scared,
we are in a high anxiety state,
the body turns up its sensory response.
So by having the conversation and calming down her anxiety,
we're able to help her pain with the conversation alone.
Since then, she's had an appointment
with the rheumatologist, the rheumatologist put her
on the correct medication, she's doing great,
couldn't be happier, and we're able to help
this patient out, but what does that mean to you?
The three takeaways I wanna give you
from a case like this is all stemming from
what you can do to make the encounter better.
And look, doctors need to do better,
the healthcare system needs to do better,
but I wanna arm you with some very useful skills.
The first, is when a doctor gives you a plan,
whether it's to take a medication, a surgery,
anything, they need to give you
at least a working diagnosis.
They don't give you that, you need to ask.
You need to ask them to document that working diagnosis.
If they don't know what's going on,
they should have even a list
of potential diagnoses to share with you.
Second, ask doctors why they're sending you
to a specialist so that, A, you're not wasting your time,
B, you're not wasting your money,
and C, you can formulate good questions
and a plan when you actually go see the specialist.
And three, this should be common sense,
but it's an easy question to miss.
When you're sitting with the doctor
and the doctor's telling you, here's the plan,
here's what you do, never forget to ask the question,
what if it doesn't get better?
How long should I wait if it doesn't get better?
And what red flag symptoms should I be aware of?
Those questions will save your life.
And if not saving your life,
they'll at least make your life a lot easier.
When you know the plan, you know what to look out for,
you're less anxious, you feel less symptoms.
House MD says it's never Lupus,
in this case it was Lupus,
but click here to watch some really hilarious takedowns
of House MD that I did, click here, check that out,
and as always, stay happy and healthy.
(upbeat music)