Letter to the doc who said I wouldn't get better

[Guest guest]

Hi, everyone,

Let me know what you think of this letter I'm sending to a doc who

told me I wouldn't get better even though I was getting better

through physical therapy (forgive me if you get this post twice if

you're on more than one v list):

I am writing this letter to express some concerns I have about the

care I received. First of all, I want to emphasize that I think you

are probably an excellent physician and scientist. Also, I also

understand that working with the some of patients you work with must

be incredibly challenging and frustrating. I know that vulvar

problems, especially pain of unknown origin, are notoriously

frustrating to treat for doctors and patients alike. I want to

share with you my experience and why I will not be coming back. I

have seen you approximately three times. In the last two visits I

have had with you my pain was noticeably decreased in large part to

the physical therapy I was receiving. In each of those visits you

told me " women don't get better than this. " The first time I heard

that I thought, " That's great-I'm the exception! " The second and

third time I heard it on my most recent visit with you I began to

feel hopeless and like my gains were only temporary, especially when

you told me that my physical therapists would " always have patients "

because women " just don't get well. " This was a huge emotional

setback that set off a pretty significant cycle of depression and

pain that negatively affected my health. Thankfully, I have other

health professionals that are working with me who were able to

support me through this. I have been off the neurontin for two

months now and I am 95% pain free and getting better every day.

You might be familiar with some of the studies that show that

physician expectation of a good prognosis for patient is almost as

or as effective as the proper treatment. I say this not only as a

former patient who suffered from a disease that is frustrating for

physician and patient but also as a mental health professional with

experience in experimental research and design. Hubbard, Duncan, &

's book " The Heart & Soul of Change " devotes an entire section

to this entitled " The Role of Common Factors in Medicine. " I

quote, " The words of the physician are powerful. Through them, the

physician conveys not only her or his confidence in the treatment,

but also she or he imparts specific expectations about how the

treatment will feel to the patient and what its therapeutic effects

will be. These words create an expectancy that has a psychological

impact and induces measurable physiological effects, " (p. 277,

emphasis mine). In 1956 Feldman (in " The personal element in

psychiatric research " in the American Journal of Psychology)

compared a drug (chlorpromazine) prescribed by both doctors that

believed in the drug and doctors that did not believe in the drug.

Physicians who were enthusiastic about the chlorpromazine had a 77%

success rate and physicians that did not believe in the prescription

had a 10% success rate. Hubbard, Duncan, & also go on to

cite Luparello, Leist, Lourie, and Sweet's 1970 study ( " The

interaction of physiologic stimuli and pharmacologic agents on

airway reactivity in asthmatic subjects. " Psychosomatic medicine.)

that beautifully illustrated that a positive physician attitude

even had a positive correlation with the effect of

bronchiodialators.

Other more recent studies have supported this research from the

1950s. It shows how incredibly important it is for a physician to

have an expectation that a client can and might get well again

rather than telling them that they will not or cannot get well

again. This is why I have chosen the people around me carefully as

I understand that their belief that I will get well and stay well

supports my belief and it has been proven that this belief can be as

important (or more important) as any medicine that is prescribed to

me. I have a lot of appreciation for your work as a professional,

especially as I have worked with very difficult " populations " in my

own field and know how disheartening it can be when my clients don't

get well. But I hope you will remember how important clinician

expectation can be in a patient's wellness.

According to Scovern in " The Role of Common Factors in

Medicine, " " Physician belief in the treatment and the patient, and

patient hope and positive expectancy, all influence outcome. In our

increasingly litigious society many physicians adopt the self-

protective stance, under the guise of obtaining informed consent, of

explaining every possible negative outcome and side effect, and of

giving the patient statistical odds of recvery, no matter how

bleak. These anxious tactics can have unfortunate consequences,

creating in the patient anxiety, pessimism, and fatalistic

expectations. A particular patient is not a statistical average.

His or her response to treatment, or even survival, may depend on

maximizing rather than minimizing the effects of the common

factors, " (p. 286).

Respectfully,