Poor MD Problem Solving With GI Problems

[londonflo]

30 plus years ago, I had a lot of 'gut' pain problems. Would go into the hospital and was just basically ignored or had gastrograffin enemas. I was told it was a psych problem. I went to Mayo. The Mayo GI department told me the majority of their patients are told their problem is psychiatric.  All the psych RXs in the world did not help. My job threatened me with termination.

A couple of decades later, one night I had the same  abdominal pain with vomiting happen again. Same symptoms, I worked the same full day. It came on without notice.  . By this time I was married. My spouse said "let's go the hospital". I explained "You don't understand...they will say it's in my head." Eventually we went in (after  4 HOUR wait) and after a CT, I had a volvulus. Why do you have to get old to get good diagnostics or have a spouse who can demand better care?

[toomuchbaloney]

This minimization of women's complaints is not a new phenomenon and well educated health professionals across the country share our concern. Here's an opinion from a contributor to a Harvard Medical blog. 

Women and pain: Disparities in experience and treatmen

The Doctor Doesn’t Listen to Her. But the Media Is Starting To.

[londonflo]

19 hours ago, JBMmom said:

I was under the mistaken impression that without treatment a volvulus would end up leading to necrotic bowel. The fact that you have dealt with this for so many years without proper diagnosis and treatment is a very sad illustration of some of the clear shortcomings in our medical systems. I'm glad you've finally gotten the appropriate care. 

Thank you. I thought I was totally alone in this problem... When I developed the final volvulus,  the symptoms were similar to previous hospital visits.  I put off going to the hospital as I thought I would be blown off again. But now I had an advocate...(my husband) and although I had to be in the waiting room for over 4 hours to be seen (and then told you may have waited too long---colostomy now) I was taken more seriously. I also told my husband I wanted to go to the OTHER hospital in our city so that my previous records wouldn't provide the health care team to think I was a 'frequent flyer'.

It had been previously identified I had a redundant colon. I had so many problems from when I was 13 to 40 with this. While surgery is not the first. second, third or forth step, Some treatment plan should have been recognized and established. My prime years of 15-40 years old  were defined by chronic constipation, abdominal pain and some really painful ER episodes. If I had been a man or had an advocate, the situation would have been addressed seriously and immediately. Not by UNNESSARY surgery BUT NECESSARY surgery. 

When I developed the incarcerated hernia,  (from the imperfect surgery the first go around) the same colon surgeons came into the room and basically stuttered and dance around the bed. So glad finally, a true surgeon took control (after 11 days of NG and NPO) and fixed the problem. 

[londonflo]

3 hours ago, londonflo said:

the same colon surgeons came into the room and basically stuttered and dance around the bed.

I was at the time for another colonoscopy (my mother developed colon cancer at 53, her father in his 70s. My first tubular adenoma was found in my 30s). My PCP recommended I go to the colon surgeon who botched my colon resection...necessitating a hernia repair.  My husband said I think you need someone else... He is a wonderful support so I changed MD. .This GI MD told me I had 3 tubular adenomas (she thought)  post exam but I had 4 per the letter.. I also heard heard her tell someone in another cubicle that they had 3 but then corrected herself.....you have a similar name and I got confused, You don't have any.

I hate to go back to Mayo as it is a long trip but I just want the most accurate opinion.  I do have to commend this MD for the fact I was actually cleaned out for the FIRST time for the exam and I have had many! I did have to start 7 days ahead, but no blame on me. I have slow motility...she did recognize this, 

[Tweety, BSN, RN]

Today the standard for abdominal pain is a CT and perhaps it wasn't 30 years ago.  Sadly, a lot of conditions were treated as "all in your head".  Glad that things have someone what improved and hope you're doing well.

[nursej22, MSN, RN]

@londonflo thank goodness you had an advocate, but it is really sad that you needed one. All those years of misery is almost criminal. 

My issues over the past few years are in part, in my opinion, being seen and screened by mid-levels who likely don't have the breadth of experience of MDs. My latest experience was being advised to get an ultrasound to r/o DVT for leg pain, even though I have no risks factors and I am on an anticoagulant. She poo-poo-ED my suspicion that I had a nerve impingement. Turns out, I have lumbar radiculopathy. 

[morte, LPN, LVN]

On 12/17/2021 at 4:38 PM, MunoRN said:

I would agree the terminology is problematic, but despite that your previous episode worked out as well as it could have given that even just a couple of decades ago they were quicker to do surgery for this sort of thing, it's now more commonly accepted that surgery should be avoided in these cases.

I agree it's not accurate to call sub-clinical abdominal issues a "psychiatric" issue, but it's not inaccurate to describe the issue as being primarily one of pain and discomfort rather than an imminent medical emergency.  That doesn't mean it doesn't justify treatment of the pain and discomfort, but it's technically correct that it's "in your head", brains perceive pain and discomfort.

You are attempting justify her poor treatment, you are ordinarily better than that.

[MunoRN, RN]

On 12/20/2021 at 4:47 AM, morte said:

You are attempting justify her poor treatment, you are ordinarily better than that.

I get that interpretation but that's not what I'm trying to say.

The premise of medicine is to find what can be fixed (medically), and if it can't or shouldn't be fixed then oh well.

I'm not a huge fan of how the common definition of nursing is often interpreted, which is that we don't treat medical problems, we treat the human response to medical problems, but I do agree there is certainly some wisdom to that.

In the case of an initial bout with a volvulus being too quick with surgery can do more harm than good, so the best approach is "watchful waiting", which then unfortunately leaves the patient's pain, discomfort, anxiety, etc unaddressed.  

This is where nursing comes in, what's needed is to deal with the human response to the issue, and describing that response as being "in your head" is accurate.  I don't agree with the argument that instead of acknowledging that nursing has more of a role here than medicine that we should just fast-forward to a medical intervention.

In this situation I've personally found Biofeedback to be particularly effective, and I don't think we give hypnosis and related therapies enough recognition.  

I know as a society we like the quick-fix, but sometimes it's not the best approach.

[Tegridy]

Probably has more to do with the ease of getting a CT nowadays than having someone with you. Back then they had to pull the radiologists leg to get a CT, now its easier. Even then volvulus can be intermittent it may have just de-torsed by the time the previous imaging was done.

[Leader25, ASN, BSN, RN]

On 12/17/2021 at 3:28 PM, JBMmom said:

Being told that something is "all in your head" can be so defeating, especially when it feels like you're not being taken seriously

Your distress is palpable,I also went thru an all in my head Dx,which turned out to be serious impacation, but the best line came from a friend who said "even crazy people should  have a right to S***".Glad you finally found out your problem.