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I am sorry but I laughed out loud at this. “…he scared the crap out of me” made me just about pee my pants. WHy is it that there are people who seem to think it is okay to confess their stupidity to someone who is going to take it personally? Narcissism comes to mind- I feel bad, so they ought not live?? Unbelieveable.

Anyways, inappropriate laughter I am sure, but only because I have met people like that and could see it come out of their mouths.

It is, unfortunately, all too common. Like all of the other voices here, I’ve had plenty of experiences of just being ignored, or told it was nothing, or told that “well, you’re more sensitive to sensory stimulation than most people, so things that wouldn’t bother us bother you. Obviously, it’s nothing then!” Nearly everyone talking at Tiny Cat Pants the other day had similar stories.

While there’s a lot of it having to do with specific prejudices and individuals being jerks, a lot of it is structural, and a lot of it is taught. We push our medical personnel to the limit during their schooling, and then set crazy hours for them while they work. HMOs and medical billing and malpractice issues make nearly every decision a nightmare cloud of paperwork, and as the doctor pointed out earlier in the thread, our system is amazingly stupid in its construction.

I had a simple visit to the ER one day (for them to give me an ultrasound and tell me nothing was wrong and here, have some Vicodin for the pain that is clearly nonexistant because it doesn’t have a cause that shows up on the screen… even though I told them that the thing likely lodged in my uterus was plastic, and the nurse had never heard of it and didn’t know where to look…), which resulted in me being (mis-) billed by three separate entities for five separate things. For the doctor’s time in the ER. For the use of the ER itself. For the use of the specific machine/technician to read the machine. For being in the hospital at all. And for having insurance.

All of those people have to communicate across agencies, across billing scaffolding, and across personnel (with different tracking numbers, differing lengths of appeal time, and differing responsibilities toward each other)… and almost all of them insist it’s not their job to track down the information they don’t have. Which isn’t insane, from their perspective; with so many players in the game, they’d be hemhorraging money left and right to keep up with things that are really “somebody else’s fault.” Besides… we’re all forced to sign papers saying that (contrary to all written law on the matter), we will pay all parties involved in the matter if anyone anywhere along the chain fucks up. Why would the companies talk to each other if that’s the case?

(That was sarcasm, in case it didn’t come across clearly)

Everything works like that in hospitals. I worked in one for a little over a year, and that was.. eminently true then. I have no reason to think that it’s changed in the past…seven or so years.

Given all that, and given the incredibly stupid ways we think about time and work in the medical profession…. you’ve got teams of incredibly tired peple under huge gobs of stress with highly fettered access to the information they need and regulations so numerous and complex the IRS would be staggered. Not a good combination for competent work period, let alone competent, compassionate, thorough work. They don’t get paid enough for that.

And, realistically, the way things are structured in ER-like and clinic-like cases, the pressure to “treat ’em and street ’em” is amplified by the sheer numbers. If you giving good care to one person comes at the expense of giving any care to two, or three, or four… it might seem reasonable to simply make sure they aren’t going to die on you right that minute and let them fight it out with their primary care physicians or whoever else. (And, of course, to get there they have to forget that a lot of people don’t have primary care physicians, or are stuck with really restrictive HMOs, or simply can’t get time off from work/appointments when they need them/rides to the doctor on short notice.) For the primary care phsycians at all but the wealthiest sites, it’s the same thing. You could ask about everything that’s wrong with one patient and make sure they feel happy and respected, or you could hand out antibiotics to five people and referrals to two more.

Conditions like these allows for the flourishing of latent racism/sexism/disablism. After all, it’s easier to believe that someone is making it up than to admit that you’re wrong, or that you’re going to have to do something time consuming (or worse – expensive and probably not covered by your patient’s insurance). And it’s easier to give substandard care if “they don’t really need it” or “they’re better off this way.” You can convince yourself of just about anything, if you have to.

Add to that the explicit teaching… from the liability crazed billing issues (“give pregnant women C-sections because we have more control!” “Don’t run any expensive tests because they might come back negative and you’ll have to run more!” “Don’t give them options because they might pick the wrong one and sue you!”) to the confrontational models of treatment (particularly as regard mental illness and substance abuse issues). It’s actually written into the texts. Trained into people. This is how you act, if you want to get ahead/cure the patient/not get sued.

Take all those things, shake and stir liberally, and you get this mess.

(None of this, to be clear, was defending that system at all. I think it’s awful. But I was trying to convey the self-perpetuating nature of the problems. It’s not just that we’re unlucky and keep meeting jerks, but that the system brings out the jerks in otherwise nice people, and makes it difficult for the good ones to do their jobs as well as they’d like.)

They aren’t “better” than us…they’re not doing their job.

Manipulative? No. Necessary assertiveness to get the right care…yes.

I did have one doctor apologize for assuming that something was just because of my weight when tests came back saying otherwise, the condition he found was serious but then it disappeared when I was finally able to follow up on it. Also when you are in a locked ward getting actual medical attention is really hard. And conditions there are very unclean often so I get sick. A nurse there told me that I had a somatic element to my psychiatric illness because I got a lung infection and some skin problems. Around the same time I broke a tooth, and was only able to get it taken care of after I left the hospitals which was months later. By which point it had decayed so badly that it required a root canal and of course since I was on medicaid crowns were not covered, the dentist did the best he could do for me. I have since moved to another state that only covers emergency dental for adults, apparently defined by severe pain. When the tooth broke again I was at first told I could even get it pulled because there was no pain due to it not having a living root. I did get a call later from someone there saying that I could have it removed, haven’t tried to yet though.

Another unfortunate practice of the level of care available to someone on medicaid is that one is only allowed to mention one issue per visit, I don’t always know which symptoms are connected but the point is I can only talk about one thing. So any long term issues are always put aside for whatever immediate symptom I have.I hate how the system works.

Sorry if this rant is too long.

I’m avoiding doc stuff myself. It could be important, I dunno. Some follow up I don’t remember the doc telling me about, that I found in the medical records I had sent. Personally, I’m tired of seeing the “abnormal psych” blank checked in my med records – just because, for example, I suggested my high blood pressure reading was “white coat” hypertension and/or made higher by being in a waiting room with a screaming child for one hour prior.

For those of you (us?) who have disgust, distrust or fear of medical stuff, I do understand it’s not a phobia. Phobia is *unreasoned* fear.

btw I’m also a Respiratory Therapist and I had 4 years of formal training and 28 years of working in the acute care setting.

I remember reading an article about dehumanization among prison guards, law enforment officers, and ER personnel. I can’t remember the citation, but the gist of it was that people who deal with people too much in such capacities can burn pit and end up viewing people as just lumps of flesh.

Re: what Kathy (#1) said: I’ve played dumb also and that does seem to makes things go better. IME I have often had lead them to the right answer or test(s). It’s wierd sometimes we have to pay these people.