It’s Not What She Thought It Was
I saw a very nice woman today as a new patient. She scheduled an appointment for “endometriosis problems”. Since this can be tricky, I scheduled a long visit. Good thing.
In my experience, patients with chronic pain tend to get frustrated. They want to get their “side” of the story out before they think the doctor is going to stop listening. This is because a lot of doctors DO stop listening and because CHRONIC problems tend to be very frustrating. They go on and on….
I had to keep going back to her story. It didn’t add up to endometriosis. I reached into my magic left hand drawer (where I keep all the neat information sheets, forms, etc) and pulled out a questionnaire for a problem called “interstitial cystitis”. This is a very painful condition of the bladder – which sits right in front of the uterus. (The plot thickens, my friends) Most people score under 10 on this “test”. My lovely patient got a 27!
Her examination (yes, Virginia, I did one of those, too) showed that her bladder was tender – the cystitis thing – but her pelvic organs were totally not tender. It’s hard to have endometriosis when none of the organs that usually have it are tender, and the time patterns just don’t fit.
I may not be the brightest bulb on the tree, but I was taught to take time and figure out what’s wrong with my patients. There is a medicine that is specific for this condition. It does not require surgery. It should not require narcotics and muscle relaxers. She was also on the wrong hormone treatment if she did have endometriosis.
Could I do all this in 15 minutes? No. Do I want to practice 10-15 minute medicine? No. Was my day rewarding? Absolutely!