Pernicious Medicine

My father died when I was 8 years old and my memory of all the details of my first 8 years on this earth can be summed up in one image: his hands helping me to stay balanced on my first two wheel bicycle acquired on my 7th birthday.  All the other images of him were generated because of the stories I was told but they are only one-dimensional snapshots of a man I would never know.  Among the stories was the tale that I was his favorite because he delivered me.  That may or may not have been true—the favorite part—but I believe he did spoil me in ways I would never again experience after his death.  Later in my life, therapists would say that I felt so abandoned by his loss that it generated years of depression and anxiety.

He was a doctor—the first black doctor in the town in which we lived—and the first in a long line of physicians who would have a profound affect on me.  This is truly ironic because his absence perhaps led me to all the subsequent physicians that I would encounter—physicians who would not be able to solve my medical problems and who would charge huge fees to come to various erroneous diagnoses derived in large part by their propensity to engage in medical profiling*.  Physicians far different than my father who was a general practitioner who made house calls, accepted food instead of money as payment for his medical services during the depression and who died in 1948 at an early age [50] leaving behind a widow with 3 grown children and 2 youngsters, of whom I was the youngest.

*Medical profiling is my definition for a set of assumptions that that allows a physician to enter an examining room and minimize the loss of the one thing that is more important to him than money:  his TIME.  He can look at the patient through the lens of this profile, make some fast judgments and get on to the next patient quickly and efficiently, thereby increasing his chance to make a profit at the end of the month.

But I digress.  Now I want to pay more attention to the modern-day physician—a man who is burdened with more than just the physical condition of his patient.  When he enters the examining room, he has about ten things on his mind and none of them have anything to do with the person he is about to meet—Me, a woman who has been a human being but is about to become his patient.

  • The limitations placed on him by my insurance coverage.
  • The realization that the negotiations that he entered into with the HMO’s and other insurance carriers in his community and state resulted in a deal that will severely diminish the amount of dollars he can expect to see from this office visit.
  • The burgeoning cost of his malpractice insurance and other legal problems.
  • The amount of paperwork that will be generated by this examination.
  • The necessity to record this examination accurately [leading some physicians to carry a hand-held recording device at all times and expend more energy talking to IT instead of the patient]
  • The overhead that he has incurred because he has to pay not only the rent on his office space but also the salaries of his lab and x-ray technicians, receptionists, insurance clerks and other various and sundry employees that he must have in order to stay competitive in the medical profession but more specifically in his medical community.
  • The chance of being accused of sexual harassment.  This creates the “never enter the examining room without being accompanied by a female nurse” syndrome.
  • The cost of his house payments, car payments and his wife’s credit card debt.  Also, the looming cost of the college education for his children but more currently significant, the cost of his children’s car payments, clothing bills and electronic needs.
  • The cost of his own college loans, if he is a younger physician just trying to break into the affluent lifestyle that most of his mentors have acquired.
  • Whatever else might be on his mind that causes him to be distracted from really being present in the moment.

Additional Disclaimer of a Timely Nature: 

  • I am not letting female physicians off the hook because I have had some counter-productive experiences with female doctors but this is not about them.
  • I don’t assume that all male physicians are insufficient because some of them are very good about remembering that the patient is also a human being…but this is not about them either.
  • I don’t presume to speak for all African American Female Post-menopausal Overweight Stressed patients but this is certainly not about them.
  • I don’t purport to speak to the plight of all depressed patients who encounter medical profiling because this is not a research study.
  • I only want to tell a story about me…

…a woman who has suffered much at the hands of physicians who are dysfunctional in the way they practice medicine.  In all my medical experiences, I have seldom met a male doctor that I think is worth the time—MY time, I might add—that I spend in the waiting room waiting to see him.  These doctors have brought into my life more pain than I had before I met them.

What happened to me will show you how medical profiling—a phenomenon that I do not believe affects only me—works and why it proliferates.  Simply put, profiling helps the physician cut to the chase.  He can listen to complaints as carefully as possible while trying at the same time to fit them into a predetermined set of definitions.

  • My own current medical profile:
  • African-American
  • Female
  • Post-menopausal
  • Overweight
  • History of the D-word

I have many things I could say about the profiling of African-American females who are post-menopausal and overweight but I am going to limit this piece to the History of the D-word because I think it is the most egregious type of profiling, one from which a woman can never recover once she has been branded.

When all empirical tests come back negative but the symptoms persist, the physician is at a loss.  The physician and the patient are at a stalemate.  He has come face to face with an African American Female Post-menopausal overweight patient and he cannot figure out what the hell is wrong with her. 

That’s where the D-word comes in.  Every physician I have ever encountered has a form to fill out called something like “Patient Medical History.”  This is usually a list of illnesses and conditions that he wants to know if you have experienced in the last couple of years.  Often period of time extends from “last couple of years” to “EVER.”  Sometimes that list is not just about you but about you and ANYONE in your family.  The illnesses include but are not limited to high blood pressure, heart disease, diabetes, allergies, cancer, thyroid, liver, gallbladder, kidneys.  But whatever the list does or does not include, it almost ALWAYS includes the D-word.  History of Depression.

It is my theory that when the male physician is confronted with a female patient, the D-word is always lurking in the background waiting to pounce.  He will proceed as if he is responding to a set of symptoms and will make an initial evaluation and order the tests that seem most likely to produce a set of answers that will explain the questions he is asking.  The D-word is like the Ace of Spades, the ultimate in trump cards.  When none of the test results render plausible scientific responses to the requested set of tests, I believe that all the physician sees is a failure not on the part of his ability nor a failure on the part of the laboratory or x-ray personnel, certainly not a failure on the part of long-accepted medical practices, but a failure on the part of the African American Female Post-menopausal Overweight Stressed Depressed patient in front of him.

I’ll be the first to admit that I suffered from depression most of my adult life.  I will further admit that there may have been times when my physical symptoms were caused or exacerbated by my emotional state but when I presented this set of ailments from 1998 to 2000, the symptoms were causing my emotional state not the other way around.  While I was not profiled by my family physician, I was misdiagnosed by him and as I was led up the food chain from one specialist to another, medical profiling began to rear its ugly head.  My symptoms were:

  • Headache
  • Stomach pain
  • Chest pain
  • Constipation
  • Diarrhea
  • Weight loss
  • Cold symptoms, including intractable cough and laryngitis
  • Flu symptoms, including muscle pain, joint pain and overwhelming fatigue
  • Sore and burning mouth and throat

The initial diagnosis was GERD and I was treated for it with massive doses of antibiotics and Prilosec until my symptoms worsened and first one specialist and then another began to suspect that I did not have GERD and started looking at me with a skeptical eye, like I was trying to put something over on the entire medical community.  After thousands of dollars were spent on doctor’s visits, lab work, hospital tests, I was finally sent to the Mayo Clinic where I was told that I suffered from a Conversion Disorder which means I converted emotional symptoms into physical ones.  That was concluded even after I had taken a Minnesota Multiphasic Personality Inventory which indicated I was not depressed but my history of the D-word had followed me all through my medical history which was enough to enable the doctor to feel comfortable  making that diagnosis.  Now it is recorded in my chart there to make sure that all future physicians would be forewarned.

I had read many stories about women who had a rare disease and were treated like they were crazy until some physician was willing to dig deeper until he found out what was wrong with them.  I had always said that if I had such a rare disease, I would die from it because no physician I knew would go the extra mile to forget about profiling long enough to dig until he found out what was wrong with me.  The bottom line is that I did have a disorder that I could have died from had it not been discovered.  After much persistence [which is very hard for someone with a history of depression and dismissal to do], I discovered I suffered from Pernicious Anemia or Vitamin B12 Deficiency.  It is a relatively common malady but it usually shows up in patients older than I so no physician thought to look for it.  It is capable of causing all the symptoms I was experiencing and more that might have caused problems later on.   The only treatment required is a B12 injection once a month.  The cost ranges from $20 to $40 per injection depending on how the doctor bills the insurance company but it is a far cry from the thousands of dollars spent on the errors of many physicians who could not or would not look beyond my medical profile.

If you take my case and multiply it by the thousands of women who are profiled, charged exorbitant fees and ultimately not helped at all, one can see why the medical profession is in crises, why health cost are soaring and physician accountability is waning.  I long for a return to the type of doctor my father was: a man who knew that medicine was art and cared deeply about his patients.

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