Dear Healthcare Professional,

I'm the kind of patient whose chart unsettles you. I have multiple psychiatric diagnoses and a few physical diagnoses, one of which is rare. I have more than the average number of medication allergies. In fact I have so many that you probably are tempted to not believe me or to consider it a symptom of my mental illness. I take many medications each day. Some of my medications have side effects and interactions you may not know about that make the usual first, second, and even third line of treatments not possible for me. I require fairly frequent labs to monitor the effects of meds as well as the levels of some of the meds. I'm 37 and I'm disabled and unable to work. I seem like a train wreck and you are probably afraid that dealing with me will take up a great deal of your day. You know how I know? I was you not so long ago. I was looking in that chart and trying to decide how long it would take to go through the basics and how much time it would take me to relate past medical history to current situation and all of that to why I was going to treat my patient and how. I was cognizant that if I could just keep those evaluations at an hour I would have a much greater chance of finishing my day in less than 10 hours. I tried to be aware of this automatic judgment because I knew it happens to me but it's hard to not do this when time forces you to see your patient both as your patient but also as one part of your schedule. The mistake that you make is when you show me what you feel based on reading only some small part of my chart. If you feel incredulous that I am saying that the doctor has told me that migraines that are severe enough may require a shot of morphine you might want to check into why I am saying that beforeyou call to avoid answering my question about when a migraine has reached that point. Or you could just ask why I think that is the next step. I actually know the answer. I'm mentally ill but I still know my own situation. In fact I am frequently reminded of how much less than ideal the situation is. See, I can't take migraine drugs. Did you know that when you called me? No, you did not. I am gradually introducing Topamax but it's a very slow process, for reasons that the doctor and I have agreed upon. Did you know that? No, you asked some vague question about did I want more Topamax but that was all you knew about it. Did you know that I only can take Tylenol, vicodin or morphine for pain? No, you did not. And if you had those few little facts in your hand you might not have made me cry. The other mistake you made was assuming that I wouldn't notice if you did not answer my question. How could you? You didn't bother to see me as more than a diagnosis list and a medication list. All I needed was to know how long a severe migraine should be treated at home before pursuing the 2 plus hour drive to the only ER where I have patient assistance for a shot of morphine. I understand that to you that sounds extreme. But if you listened to me or read my chart it wouldn't seem so extreme, especially if you knew that I have had 2 days of migraines in a row and the one yesterday kept me awake all night with severe pain despite 4 doses of vicodin before it stopped. Instead all you would say was "If you think it hurts THAT BADLY (read between this lines, lady: migraines do not hurt THAT BADLY) then you should go". You refused to help me and I know it was because in your mind I was drug-seeking or being over-dramatic. Let's talk about making me cry. You knew you did. Yet you refused to ask why or if I was ok. I think from some defensive comment that you made as you continued to talk down to me, as you did through the entire phone call, that you decided that you knew all about me and that you knew that nobody would ever let me get away with my delusions but you'd just humor me and get off the phone. There's some world-class empathy. Do you want to know the end result of our little talk? I won't be going to the ER unless I am in so much pain someone else decides for me. You reminded me of how people treat me who don't want to be bothered to take 5 minutes to understand my history, people who merely see me as "that bipolar woman in room 7" and then refuse to listen to anything to might make the migraine the focus of my visit. Finally, don't call me "hon". I'm 37, not a child and if you are who I think you are I'm older than you are by about 15 years. I don't like being talked down to, especially by someone who is repeating herself and not listening to me but treating me like a toddler who needs soothed after not napping. You have no way of knowing whether some day it will be you with the mental illness and another healthcare professional refusing to have a conversation for 3 minutes with you. If it is, I hope you remember me the way I remember the times I was too focused on what I was doing rather than who I was doing it with. Sincerely, Jen PS. Any patient with a severe headache should be screened for signs of a stroke....Just because I'm mentally ill doesn't preclude that and since my brother had one as an infant it's better to be careful just in case. I do believe you did a rotten job and I turned around and told the dr. in an email that you were fine I was just frustrated by the situation. I was wrong. Good thing I like him. Copyright 2006 www.masterofirony.blogspot.com