A Medical Trojan Horse?

Is it ever possible to extricate yourself from the preconceptions of any medical professionals you have to deal with?  This is a question that has been plaguing me a lot of late, due in part to the well-recorded gender biases within medicine, but also because of a slightly unnerving encounter I had recently.

I had never really considered a Pain Clinic as a viable option for my challenges as Endometriosis has had me in its grip for almost a lifetime; but as it was the only treatment offered for my Fibromyalgia, I knew that it would be the only way to stay on the specialists’ radar.  So I waited patiently for almost five months for the patient assessment in the hope of not being thrown onto the medical scrapheap.  I was informed that I would be appraised by both a physiotherapist and a psychologist before a determination could be made about my suitability for the programme.  Psychologists always make me nervous, probably because I’ve watched way too many crime shows, so I was concerned that I would appear to be showing the signs of Anxiety: even though I do not actually have any of those symptoms. As it turned out the Psychologist was most definitely the more amenable of the  two.  He reminded me a little of Dr Niles Crane, from Frasier, and was very forthright with his medical questioning as well as being a careful listener.  We laughed together a couple of times and he reassured me that my enquiries regarding Dignitas (at the beginning of 2014 when I was still waiting for a diagnosis, and living life like a re-animated corpse on a daily basis) were definitely not a sign of suicidal thoughts.  The only dilemma was that I saw him after I was assessed by the physiotherapist.

The physiotherapist I met that morning was personable; personable and chatty. So chatty…

I will admit that I have a hard time with physiotherapists.  Again, I have only gone along with the ‘I’m referring you to a physiotherapist’ line of treatment to ensure that there is lasting evidence that something was physically wrong – if I felt as though there were any choice in the matter I would most certainly choose to stick with the Osteopath I know and trust.  It’s true that I’ve only met a handful of Physios, but each one of them emanated a strange, slightly judgemental vibe; and, as I am hypersensitive to touch, the ones who actually decided to treat me (rather than just printing off a page of exercises) would always send my nervous system to a highly agitated state, exacerbating the original problem.  Funny how I never have that reaction to osteopathy, eh?  The physiotherapist I met that morning was personable; personable and chatty. So chatty… Every question seemed to arrive at the end of a mini-monologue, and each of my answers was slightly remixed; leaving me to explain everything I had said twice.  I had to remind him several times that I was there because I had no other treatment options, and that any pain I was experiencing was secondary to what I felt was the real issue, which is fatigue.  At points, I had to produce letters from other specialists (I never see a new practitioner without carrying pertinent medical notes and letters) to prove to him that not everything I was experiencing was due to my nervous system ‘living in fear’.

My thoughts were still full of rehearsals for how to deal with a ‘mind doctor’

Approximately fifteen minutes in he said something that obviously made perfect sense to him but left me so baffled that, even at the time, I could only remember a few words, and those were buried within a context that was completely foreign to me.   Essentially what I heard was “Blah, blah, blah housing benefits blah, blah…” I stared at him, brow furrowed, as I tried to comprehend what the hell he was talking about.  Seeing the clear confusion on my face, he said something else that made little sense – it may have been in the form of a question; I honestly cannot remember. “ I don’t claim benefits,” I said, wondering if that was the question he was asking.  Now he seemed confused and asked me if I wasn’t entitled to financial help.

he was so willing to contradict the diagnoses and advice of both the rheumatologist and the orthopaedic surgeon

At this point, I must state again that I was still more concerned about the psychological assessment that was still to come. My thoughts were still full of rehearsals for how to deal with a ‘mind doctor’, not allowing much room for immediate analysis: so I just assumed the man I was talking to had been living under a rock for the last five years and reminded him that disability benefits work on a points based system – it can be incredibly difficult for someone with a fluctuating illness to be awarded the points they need for government assistance.  It wasn’t until I returned home that I realised that he was assuming that I was living off the State.  All of those odd little comments about money worries causing enough stress to stop the body from healing itself suddenly made sense.  It also explained why he was so willing to contradict the diagnoses and advice of both the rheumatologist and the orthopaedic surgeon; the latter of which had told me not to return to yoga practice before the full effects of the ultrasound guided injection could be inspected – basically because surgery could be needed in the near future to remove any spurs.

Now, I’m not saying that there is anything wrong with needing State assistance, but I’m one of a lucky minority who is able to be supported by my husband until I’m no longer a professional patient: so the supposition that I was living in an environment of financial duress and uncertainty is fairly far from the truth. Most of the stress I actually experience comes from having to constantly play a game of medical Tetris.

My concern here is that he made these assumptions before I had even spoken a word and subsequently modified my answers to fit the narrative he had already created in his mind.  Thankfully, the full assessment requires input from both professionals, so the hope still exists that the psychologist (who has seniority) will balance out some of the political narratives that the physiotherapist was weaving into his notes. The real problem remains, however, that I spotted this bizarre internal bias too late to raise a challenge to the incorrect hypothesis. For my own well-being, I cannot allow that to become a poor habit…