Mental Health and the Doctor-patient Relationship: It’s All about Trust
March 14, 2019
So I walked into the appointment with my sunglasses on and my earplugs in. With my sullen-looking face drooping down. Swearing under my breath when I found out that the forms I had just spent 30 minutes completing online at home were only useful if I had printed them out. The fact that they couldn’t access my online forms from their own online system, and I now had to fill out more forms, had me seething. It was the wrong day to waste my time.
After 40 minutes of sitting in the exam room waiting, the doctor appeared approachable in her colorfully-patterned leggings and demeanor. She apologized for taking so long and asked me why I was visiting.
I stated that I needed to find a general practitioner, which was true, and that I needed a prescription to continue to see my occupational therapist (OT) (my original prescription had run out and the doctor who prescribed it for me was no longer available to write another script), which was the main reason I was there, but I didn’t want this doctor to feel used, so I decided to go along with answering her questions.
She asked me to tell her about myself. I didn’t know where to start. Up to this point, I’d never had a good experience visiting an MD. They always seem to want to categorize my experiences a certain way so they can prescribe me something. A method that has never worked for me. So I told her I have sensory processing disorder (SPD), which seemed like a good place to start.
While listening, she was typing her notes on a computer, and I sensed her struggle finding the code for SPD, so I told her the code was G969. I believe it’s called a disorder of the central nervous system, I said. SPD is not in the DSM, I further explained, So you will not find a code for adults. Is it showing you a code that starts with a “B” I asked. Yes, she replied. That is the code for children, I said. Oh, she replied, as she typed in the code I gave her, obviously not very familiar with SPD in adults.
I also told her I have PMDD and endometriosis and mental health issues (which was also in both the online form and the additional forms I had to fill out upon arriving). I told her I’ve had gastrointestinal (GI) issues in the past, when I was prescribed pills that negatively impacted my digestive system, but I now use food, vitamins, minerals, probiotics and essential oils instead, and I no longer have GI issues. I told her I also take an herbal-botanical supplement that balances my hormones. She nodded.
She asked if I was seeing someone for my mental health issues. I told her I have a psychotherapist whom I’ve been seeing for five years. I didn’t mention my specific obsessive compulsive disorder (OCD) and social anxiety disorder (SAD) diagnoses, but I didn’t see the need to. I also didn’t mention my post-traumatic stress symptoms from having a front tooth knocked out, but again, this information didn’t seem necessary.
The doctor told me to hop onto the examination table so she could take a look. As I sat on the table and removed my sunglasses and earplugs, she asked me if my sensory issues were always this bad. Yes, I said, The fluorescent lights distort my thoughts, but I’m always more sensitive right before my period (which is also something I noted in the forms she had with her). She, again, nodded her head.
As she checked my ears, she asked me when my sensory issues started. I told her since birth. That I had colic and was sensitive to sound, smell, taste and touch. That I used to rip my clothes off and only eat certain foods. I didn’t get into too much detail, but she seemed satisfied and nodded again.
She’s actually listening to me, I thought. But then, our visit took an unfortunate turn.
Have you ever had a root canal, she inquired, seemingly out of nowhere. Yes, I said, I’ve had about four. How old were you, she asked. I got a tooth knocked out when I was 19, I said, And that was my first one. For my second one I was about 26, I said, And then the others took place in my early 30s. Why do you ask, I said. Well, she said, sitting back down in her chair, There’s no such thing as a clean root canal.
As soon as she said it, I felt my heart stop. This was not something that was healthy for me to hear. But I was curious so I listened further.
She went on to explain how root canals leave scar tissue and how she recently met a doctor at a conference who was working with scar tissue in patients and he found that when he worked with scar tissue in one woman (who had a scar in her abdomen) a flood of emotional issues surfaced. I nodded.
I told her that I’ve read a lot about how trauma sits in the body and that when I see my OT, the craniosacral and chakra work we do releases some of that for me. She didn’t inquire more about what I was saying. The mind-body connection now lost.
The doctor continued on about how I could have an infection in my mouth that is causing all my issues. My sensory and GI issues that have been present since birth. And my first root canal was at 19. The GI issues that got worse as I got older when I was prescribed chemicals, but that I explained had already been solved.
She said I needed a 3D cone X-ray of my mouth, and that if my dentist couldn’t do it, she’d refer me to someone who could. I asked her what would be the treatment if I had this infection, thinking I would be prescribed another pill. She said quite candidly, Oh, pulling your teeth out. I covered my mouth with my hands and said forcefully, This isn’t something that’s good for me to hear! And my body immediately went into fight-or-flight mode.
As I sat there, frozen, she explained to me how the next steps were to get the X-ray, to get some blood work and to report back to her so she could see if I did indeed have this infection. This reason for all of my problems. That she was guessing I had.
I just told her minutes ago that I struggle with mental health issues, and she had it written on two sets of forms, and yet here she was feeding my mind information. The bad information that is pure fuel for a mental health issue. The kind that can drive someone mad.
My Response to the Exam
I was a wreck when I left. I sobbed immediately once in my car. I struggle so much with the thought of getting dental work done or losing teeth—it was like she sucker punched me in the mouth and I was getting a tooth knocked out all over again.
The thoughts stayed with me all day. And my mentally and emotionally unstable mind wanted to keep them to myself. To hoard them and to hide them. But I shared them. Because I’m learning that’s what makes them feel better.
I first told my husband. What!, he exclaimed, laughing. That’s bullshit. What is she even basing that off of, he said. And I immediately started to feel better.
The next day, the bad thoughts were still swirling in my head. The feeling of getting a tooth pulled was one I could not shake. It made my gums ache. My TMJ flair. Sending my already on-edge nerves over the edge.
So I told one of my healers. She helped me see that the doctor shouldn’t have said that to me, especially because she had no evidence that I could possibly have it. Especially because my mental health issues were written all over my forms and all over my face. That the doctor shouldn’t have put that thought in my head. A thought that caused me anxiety. Tears. Loss of sleep. Pain. Made that disgusting, dark feeling creep back inside of me. The one I was already fighting extra hard to brush off.
For as understanding as the doctor seemed in the beginning of our visit, she didn’t seem to grasp the most important aspect of our brand new doctor-patient relationship: establishing trust. And she broke mine right away.
She crossed a line with me that you can never cross back over. Because once you show me you will ignore my mental health needs, there is no way for me to trust that you won’t do it the next time. And the next time. And the next.
Years ago, before I started getting better, her words would have thrown me into an episode of negative thoughts that could have lasted months. Of feeling like my mouth was rotting and positioning my insides. Making me feel sick. Unable to eat or to rest. Taking away my days. Thoughts that I had to fight away this time. Now, they simply made me not trust her. For if she is willing to jump to such a large-conclusion without any evidence, not to mention while overlooking my mental health needs, what would she say with evidence.
What she said to me took me two days and a good amount of physical and emotional pain to sift through. Hopefully her diagnosis was as factual as her evidence. I will, however, follow up with my dentist, whom I trust, about this phantom diagnosis.
Put your mental health first and don’t expect doctors to. Follow your intuition. Talk to your loved ones about your thoughts and diagnoses. Find healers who know you and who can help you. Only work with doctors and health-care professionals you trust. Get second and third and forth opinions until a diagnosis rings true for you. Don’t let the words of one person open the door to negative thoughts. Your mental health will thank you for it.
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This story originally ran on Psych Central on March 15, 2019. Since Psych Central has been sold, the link to the original is no longer available.
Image by David Mark from Pixabay