War or the worst medical consultation of my life
When I was in Poland in the summer, I decided to see a doctor. I thought of the visit as getting a second opinion, just to allay my slight worries. It turned out that I had just about the worst medical consultation in my life, well, as far as I remember. This blog is an account of what happened as I remember it. Needless to say, it is told in a way to make it interesting, so I omit fragments of the consultation which were not significant in the context of this post (such as, for example, taking family history).
I went to the largest provider of private healthcare in Poland, paid for a cardiological consultation and a couple of days later I happily went to see a doctor, who, incidentally, sported both a medical degree and a PhD, which I thought augured well.
I was welcomed by a female doctor with a friendly smile who invited me to sit down and asked what the purpose of my visit was. I described the issue, but, as a good patient, I decided to give her some context and told her about my CFS diagnosis. Her reaction was something that I will remember for a long time. She burst out laughing and said:
Is this what they told you over there?
I must admit that as much as I am quite a gobby person, I was stumped. For a few moments I was considering telling her what I thought of her, leaving and demanding my money back. I decided to stay, though, I actually wanted to know what would happen next. And so, I played along.
In a few curt words, I explained that her ignorance of CFS did not mean that it didn’t exist, but, in fact, it meant that she should go and find out about it. And that we, in the civilised world, are not used to doctors who smirk at us. She took me up on the references to civilisation, to which I said Polish doctors had clearly a way to go. That didn’t go down well at all, but the consultation continued, after all I paid a not inconsiderable amount of money for the visit, with me more and more relaxed, and the doctor more and more irritated.
As the interview continued, the doctor asked me whether I was on any medication. When I responded with statins, what became the highlight of the visit began.
In a raised voice, I was asked if I knew how dangerous statins were, how pointless taking them was. I responded with saying that I was fairly familiar with controversies around statins and asked whether she was an anti-statinist. Not only was she an anti-statinist, she was also anti-big-pharma, and anti-much more, though memory fails as to anti-what exactly. As I was being told that I should become a raw-fruit vegan (I responded with a question about white wine, specifically, sauvignon blanc, which the doctor might have correctly taken as piss-taking), I was told to take my shirt off. The doctor was going to do an ultrasound examination of my heart. It seemed like 10 seconds after which she announced that I had a major problem with my heart, obviously caused by the statins, and not being vegan (she wasn’t either, I asked).
Another 10 seconds later I was already sitting as the medic was taking my blood pressure which was highish. I said, you know, after the news you’ve just delivered, I am a bit anxious.
- I have a very calming effect on my patients, the doctor said.
- They must be lying to you, I retorted, very pleased with myself.
It was war, after all, and I was not going down without a fight. The doctor looked at me with thinly veiled hate, and sent me for an ECG, ordering me to come back afterwards. I started enjoying myself.
To my surprise, when I came back, the cardiologist had already read up on CFS. As I sat down, I heard that ‘obviously’ I had no CFS, it was a clear and obvious misdiagnosis. So, what do I have, I asked almost unanxiously. And here came the highlight. She said something like:
You have completely wrecked your heart by those stupid statins, and now you’re ill. And even though your ECG doesn’t show anything, my experience says that you are ill, and we must confirm the illness. It’s more than likely to be X, so I am sending you to hospital for A.
(X is an illness whose name now escapes me; A is a fairly invasive cardiological procedure).
I looked at her with disbelief. So, you’re saying that even though you see nothing, you still think I’m seriously ill. Yes, she said, I am an experienced doctor and that’s what my experience tells me. Statins are dangerous, you should never have taken them, she added. My eyes were opening wider and wider.
Two comments. First, I hope you noticed the ascription of agency to me. I wrecked my heart. Not the doctors who prescribe the bloody statins, not the bloody statins themselves, but I did! I must admit that when I heard it, I thought it would be the highlight of the blog I’d write about the consultation and just hearing this was worth staying and playing along.
The second thing I want to note is the certainty with which she was saying things. There was no hesitation in what she told me, she was telling me ‘how things were’, no qualifications. She really was sending me to hospital, as I was really ill, it just had to be confirmed. As I came to allay my fears, I was about to come out with a serious heart illness. I tried to negotiate, to no avail, she was adamant.
Before I conclude, let me say that, of course, I didn’t go to any hospital, I had no procedure or anything of the sort. However, I did see another cardiologist who told me I had a surprisingly healthy heart for my age. I also discussed the statins and the discussion was very useful. Go figure.
Conclusion. This was a consultation from hell. The doctor’s inability to communicate was staggering, unbelievable. She was incapable of listening. The swiftness with which she was jumping to conclusions and the certainty with which she was announcing them were jaw-dropping. And then, the absence of empathy – even for a hardened and thick-skinned patient like I am, it was hard to take. I actually commented on her certainty and bluntness, to which I heard that maybe in the UK doctors pussyfoot around, she certainly did not. I agreed with her wholeheartedly here, which she took with suspicion as I was laughing.
For me the consultation ended about 2 minutes after it started. I became completely uninterested in anything the medic had to say, for me it became war, I wanted to pay her back for trying to undermine me. I was trying to irritate her as much as I could, and, to my satisfaction, I was quite successful in this. To be completely honest, as we fought, I was wondering whether her pronouncements at the end of the visit were an attempt to pay me back (I’m only saying that the thought had occurred to me, nothing else).
I survived the visit because I could see what was happening, how we were communicating. I survived it, mostly untouched, if you like, because I quickly started only pretending to be a patient. And, in fact, I was only observing what was happening. Otherwise, the visit would have been very scary and traumatic. Having said this, I still left shaken and immediately phoned a good friend for advice on a good cardiologist.
Now, I really don’t want this blog to be taken as an indictment of Polish doctors or Polish medicine. It’s not. The second cardiologist I saw could not have been more different. This blog is aimed at restating how important it is to teach medics how to communicate, how to relate to their patients. But also how to make claims and express judgements (let alone form them) and how to espouse uncertainty. For even assuming that my cardiologist-from-hell meant well (and I do prefer to think that), the certainty with which she spoke was utterly misplaced.
The final thing I want to say is that I always wonder about the extent doctors I see realise that I watch them, I listen to them, I also make judgements about what they do and say, what they claim. For sometimes I wonder if they think that either they’re invisible, or I am completely dim-witted. And they would be surprised to learn that they’re not and I am not.
PS. The irony behind this blogpost is that the doctor from hell was right. It turned out I did need the procedure she’d recommended. And my ignoring her recommendation resulted in my ending up in an Intensive Care Unit a few months later. I hope this serves as little jolt for all those medics who think communication doesn’t matter.