Letter from Doctor to Patients with Chronic Illness

Thanks to JC Colyer for sharing this very inspiring message of a "Letter from Doctor to Patients with Chronic Illness" as written by Dr. Rob on July 14, 2010, in BEING A DOCTOR, BEST OF, JUST STUFF KIND OF THINGIES, PERSONAL MUSINGS.

It reads:

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:

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.
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.
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.
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.
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.
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.
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.


Dr. Rob

Ben and JC

Thanks for sharing this letter. Two things struck me, that we scare them, and our understanding has torn down the doctor-God illusion. The first time I saw my PCP after my diagnosis I thanked him for recognizing my symptoms and explained to him that my mom went her whole life un-diagnosed. I'm lucky I have a good relationship with him. The first time I met with my Rheumatologist - he asked why I was here? I wasn't expecting that, I thought he knew and I said my PCP sent me... I just thought I had RA? Upon examination he said the inflammation was worse on my left side although I'm right handed. He ordered more blood work, and it came back lupus. Each visit the ice melts a little more, but we have a way to go. But all I know about Lupus I learned here and from my own reading. He never told me to avoid the sun?

11 Years ago, I had a gastric by-pass and lost 75 pounds. The patient counselors and many of the nurses had gone through the procedure themselves. My nurse post op, also had gone thru the procedure. Wouldn't it make sense to have someone available in our doctor's offices who understand us? When I was diagnosed - I was handed a booklet which I went home and read and then cried my heart out. There should be a softer, easier way.

Two months ago I had the worst visit with my family physician. Went in to see him after starting a new medication that was causing some weird sideffects. Couldn’t reach the doctor that had originally prescribed it. Figured he will tell me what I should do since he knows my history dealing with Sjogrens and lupus. He had always been very supportive, understanding and knowledgeable when dealing with new symptoms and treatments.
Two months ago, I went in to see him. Wanted to see if I he can tell me whether it was ok for me to continue the medication or stop it. To my surprise he was really upset for me even going to see him. He told me that if the medication was helping with inflammation and pain that why question it. That their is no reason to stop it and just deal with the sideffects. Then he continued on telling me that he felt I was the type of patient that is very negative and that my negativity is destroying my family. I assure you I have never thought of myself as negative. I am the type of person have always worked hard to better myself whether it be financially, academically,parenting, marriage, advocate for myself and my kids. Having lupus has made me weaker in mobility but has not changed me as a person. I believe that the best treatment for any problem is education. Learning and teaching yourself how to best handle a new situation. With that said I am optimistic that I will get control of my symptoms but it will take more time and It will not be easy. I know that but negativity is not no where near my mind nor is it healthy for my health and my family.
Why in the hell did he say that? Obviously, I froze and didn’t say anything. He continued to go on and I just blanked out. I could hear him talking but all I was thinking about was him calling me negative.
I started actually convincing myself that maybe he was right. Trying to think back what I had done or said that would convince me that he was right. I started to cry but tried my hardest to hold my tears back so he will not see me crying. He saw my eyes water and my speech choke that he changed his tone of voice.
I just wanted to run out of their so quickly but had my daughter with me and did my best to hold my compojer and not fall apart in front of her.
Right after, i met my husband for lunch and when he asked how it went had a hard time talking about it without crying. What was worst was that my daughter witnessed the whole thing and told my husband that the doctor was really mean to me and that I didn’t say anything. Which is not me to not say anything.
Felt really humiliated, betrayed and hurt. I have spoken so highly of him, and recommended him to all my friends, co-workers and family. Even my husband sees him for his back and carpal tunnel.
After a few days I still continued taking the medication and ended up have a severe allergic reaction from it and ended up staying in the hospital for a week and placed on a high dose of prednisone for two months. Still dealing with mild Vasculitis all over body.
Now currently looking for new primary doctor.
Wish me luck.