When Your Doctor Doesn't Listen

[Nurse Beth]

Day 24 of an acute sinus infection.

Today the pressure/pain has traveled down from my forehead to my upper back teeth. Last night a strangly cough kept Bob and I up. I finally got out of bed at 3 am so Bob can sleep and am now on the living room couch.

I can't sleep at night, am fatigued during the day. Over the last 3 weeks, I've used up all my sick time. I keep going to work only to go home early. At work, I feel like a contagious leper and keep telling people (who don't want to know) my entire "cold story" and how I'm really not contagious.

On Day 1, I came down with a severe cold. I haven't had a cold for 3 years! I pride myself on meticulous handwashing, and not touching my face, esp at work.

But then Bob came home with this awful bug. And right before Thanksgiving! Totally not rational, but I'm still blaming him.

With a history of developing hard-to-treat secondary sinus infections, I was dismayed.

Sure enough, on Day 5 of the cold, I felt better, only to get re-sick on:

Day 6. Chills, sweats, brain fog, copious mucus production, cough, cough, cough.

I called my wonderful PMD who through trial and error had long ago started prescribing Bactrim for my Amoxicillin-resistant sinus infections. He was on vacation.

I could, however, see Dr. Z that afternoon.

Great! *cough* I could be well by the time we have 15 **cough, cough**house guests for Thanksgiving **sniffle**

The waiting room was empty while I waited 25 minutes before being called back. Not too bad. I explained my symptoms to the young doctor who stared at her computer the whole time, ending with "I have a sinus infection. Please don't prescribe Amoxicillin. It doesn't work for me. Bactrim works"

She looked up at me balefully from her computer, taking in my nursing scrubs, as I had come from work. "Bactrim is not indicated for upper respiratory conditions" she informed me. I could almost see the textbook pages turning in her mind.

"Yes, but....I've had a lot of sinus problems...it works for me " I trailed off, lamely.

Silence. She tapped at her computer.

(Uh-oh- had I crossed a line? Was I the dreaded "nurse-patient" and person who claims "I know my own body?")

"I will give you a Z-pack. Come back in 5-7 days if you're not better"

Once home I dutifully took the Z-pack... I felt about 50% better but two days after finishing the antibiotic, I became re-sick. Oh, no!! Not again.

Once again I called and was told that only Dr. Z had an opening that day, the afternoon before Thanksgiving. I greeted her with a smile "Well, you said to come back if I wasn't better. I'm sick"

I described my symptoms, and my observation "I think the azithromycin suppressed the infection, but didn't get rid of it." Smile. *cough*cough

"That's not possible. You felt better, right?" I nodded. "So the bacteria was susceptible. It's either susceptible or it's resistant. It either worked or it didn't" she patiently informed me.

I was speechless "But...but I'm sick!" Lame protest, but I couldn't even find any words.

"You are having allergic symptoms. You have allergies"

"No. I don't have allergies" (Did I fall down the rabbit hole?)

"This is a natural response after a cold. It's residual cells and debris you are coughing up. I do not recommend an antibiotic. If you want an antibiotic, I will give you one. But then you are at risk for other more serious infections, like C diff"

(wait...I'm an antibiotic-seeker and she threatened me with Cdiff??)

Properly chastened and afraid she'd change her mind and withdraw the promised antibiotic, I remained silent.

"I'm also giving you Flonase. Oh, and drink some tea with lemon"

Right. I went home to bed, passing my kitchen counter which was filled with cough drops, Zicam (pricey and questionably efficacious, Nyquil, Mucomyst (does work well), and more.

It was the night before Thanksgiving, and my daughter and her family of 5 drove in as I was taking my first Amoxicillin. Yes, that's what she prescribed. Amoxicillin.

Today is Day..did I say 24? I'm not sure. Week 3 at any rate. I have taken 5 days of Amoxicillin and am still sick. I called and have an appointment today with another provider. Wish me luck.

What went wrong? This doctor did not listen to me. I have long said that that doctors and nurses both need to listen to their patients. Not listening to another conveys disrespect.

The best doctors (like my usual doctor) partner with their patients and agree on treatment. There is evidence-based practice, and there is practice-based evidence. Both are important.

I do think I will finally get the right antibiotic today and soon be well. I'll keep you posted! I also plan to circle back with this new, young doctor who does everything by the book.....and nicely tell her my story. So this doesn't happen to her future patients. Who may not all be textbook patients.

Now I have to get ready for work and a 3-hour nursing assistant in-service I'm due to present in a couple of hours. I may include the topic of listening and respect.

Cheerful update: Saw an experienced PA yesterday who: gave me a Rocephin IM injection (ouch!); Kenalog (steroid) injection; Bactrim Rx. Shook my hand and said "Beth, I think this is going to work well for you". Am sending his office See's candy and a thank you. ?

[mmc51264, BSN, MSN, RN]

to Kooky Korky

Yes, he referred me to the pain clinic within our health system and has deferred my pain management to them. It is all in one system so he can see what they do, read the notes, etc. Out health system is EPIC so all my providers can see what the others do. The only one I have out of that system is my OB/GYN. I have been seeing him for 11 years, since I moved to NC.

I am very up front with all my providers.

[BostonFNP, APRN]

I know I will not be popular but I do feel compelled to speak from the prescriber side of the table.

We deal with scenarios similar to this every day in primary care, often multiple times per day. Overtreatment of uncomplicated ARS/ABRS is responsible for a considerable portion of the antibiotic resistance we are currently faced with in this country. There is a huge body of research on the topic. Naturally "younger" providers will practice in a more black and white, by the EBP guidelines fashion; I am not sure this is a bad thing. There is still an art to medicine as well as a practice of medicine and over time as you get to know patients you have a better understanding of how to best manage them. While I agree with previous posters that it is important to engage your patients in their own care and take that into consideration when developing their plan of care, but at the end of the day it is my job to do what I think is best for the patient, and sometimes being the best provider means that I say no to a script. A good provider isn't your buddy, a good provider does what they think is best.

FWIW, I lost a family member to complications from ABRS. I understand the human side and I do my best to balance that with EBP but I am very conservative with antibiotics (and opioids for that matter) and I stick as closely to guidelines as possible. It doesn't mean I don't listen, I do, but I don't always agree.

Also, Z-pak for ABRS is even worse, at least use a reasonable abx.

Ok, grab your pitchforks and give me a head start.

[SaltySarcasticSally, LPN, RN]

Not a sinus infection but constant GI issues over 10 years lead me to several GI doctors like the one you wrote about here. Do not listen, assume they know what it is, and kick me out the door before I even have a chance to explain. I had a doctor tell me my GI symptoms were due to stress after I lost 30 lbs in 5 months and had several stomach attacks even while consuming a very healthy diet.

I suffered for those 10 years until one GI decided to actually open his ears, order an MRI, and find the Crohn's that had sneakily been destroying my small bowel for years. I sincerely wanted to send the report to every GI who had essentially ignored me but obviously no one has time for that. It's furthered my disenchantment with doctors in general (although very thankful to the GI who diagnosed me) obviously not good when your a nurse. I am not sure when doctors learned to stop listening and start talking over patients but it's a wide spread disease that needs to be eradicated. Glad you found someone willing to listen!

[katfish67lpn]

Not a sinus infection but constant GI issues over 10 years lead me to several GI doctors like the one you wrote about here. Do not listen, assume they know what it is, and kick me out the door before I even have a chance to explain. I had a doctor tell me my GI symptoms were due to stress after I lost 30 lbs in 5 months and had several stomach attacks even while consuming a very healthy diet.

I suffered for those 10 years until one GI decided to actually open his ears, order an MRI, and find the Crohn's that had sneakily been destroying my small bowel for years. I sincerely wanted to send the report to every GI who had essentially ignored me but obviously no one has time for that. It's furthered my disenchantment with doctors in general (although very thankful to the GI who diagnosed me) obviously not good when your a nurse. I am not sure when doctors learned to stop listening and start talking over patients but it's a wide spread disease that needs to be eradicated. Glad you found someone willing to listen!

Well don't you know many of them think because they went to medical school it gives (some of) them the ability to make those decisions without really listening to what a patient is saying. Like when my son awoke with a fever of 105.0 with vomit and diarrhea spread from one end of his crib to the other. I took him to my regular pediatricians office and saw a fill in doctor who acted as if I was a hysterical, irrational mother and told me "if it takes three of us to hold him down, he is fine". It btw did not take three of us to hold him down. My husband was in the room but certainly had no part of the exam so wth he was talking about I didn't know but he told me my son was fine. I foolishly thought he knew more than I did and we brought my son home. Hours later his fever believe it or not had gotten higher. He was on fire and screaming between the vomiting. I called the local Children's Hospital and spoke with the triage nurse who told me to get him there NOW!! She said I shouldn't have waited so long, he should have been seen before now. I didn't have the time to tell her he HAD been to the pediatrician a few hours ago WHO TOLD ME HE WAS FINE!! When we got to the hospital they started IV fluids etc... They asked me if he had ever been on antibiotics to which I said "Yes, just once, about a month ago for an ear infection". They told me it was a long shot but since they just so happen to be doing a diarrhea study they wanted a stool sample and they found he had C-DIff. They told me really that most likely it since he had only been on antibiotics once and it had been a month ago, C-Diff wouldnt have been something they normally would have checked for. Anyway he started on Vanco and made a quick recovery. But I KNEW my son was sick! Further medical intervention was delayed because I listened to a doctor who didn't have the time to actually listen to me and because I thought "he must know more than I do...He is a doctor". I, from that moment on, have always listened to my mothers intuition and it has never let me down!