Healthcare

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Routine Doctors Appointments

Why have my insurance plan and my annual schedule conspired to make January the month when I have All the Appointments? I was trying to make plans to write with a writing friend and I looked at the calendar and it is PACKED. I feel like January is nearly over and it has only just begun. 

One of my upcoming appointments is with my OB/GYN, and I have been steeling myself to insist a little more forcefully that I believe I am in perimenopause. You will likely not recall that last year, my tentative questions about it were dismissed due to my age. The array of symptoms that seem to be perimenopause-related continues to grow, so I just want to confirm that a) yes, this is happening and b) there is nothing I can really DO about any of it, beyond what I am already doing. (TMI note: I take oral contraceptives which both prevent a period, so I don’t have that to clue me in as to actual menopause, and, according to the OB/GYN, oral contraceptives are supposedly the first line of defense against perimenopause symptoms anyway.) I had also been steeling myself to ask for a physical exam this year, should it be bewilderingly optional as it was last year, but I am pleased I am relieved I see from last year’s post that I should expect a pap test this year so that shouldn’t be an issue.

The other upcoming appointment is with a new-to-me internist. I have been mildly fretting about the appointment for, oh, several months now. I am eager to have a primary care physician again; my last PCP, whom I adored, prescribed me a new medication two Decembers ago, then went on leave until March, then left her practice to become a concierge physician. I love her enough that I strongly considered following her to her new practice, but I did not. Anyway, I have ostensibly been without a PCP since December of 2023. The old practice has been kindly refilling my prescription all this time, but I will be relieved to have a regular doctor again. (Yes, it has taken me since approximately March of 2024 to get in to see a new physician. This is both because I wanted a doctor whose office is closer to where I live now and because I wanted the specific provider my husband recommended.)

The thing I am fretting about is that this appointment is about establishing me as a patient… but I also have A List of things to discuss with the doctor. So I am worrying both about coming across as someone the new doc wants to have as a patient… and about addressing my concerns. 

Is the first fret ridiculous? Yes, yes it is. I can acknowledge that without being able to eliminate it from my worry database. I am sure this doctor sees a thousand middle-aged women just like me; I am not going to be any more or less desirable as a patient. Plus, physician’s job is to deal with the patient in front of them, not reject them based on some sort of Simon Cowellian checklist. (Is Simon Cowell still a contemporary reference?) And in any case, physicians treat patients all the time that they might not otherwise hang out with or befriend; we do not need to be besties. 

STILL. I want to make a good first impression. That’s weird, right? And yet, there it is. 

Let’s move on to the less-ridiculous portion of my frets, which is how to address all the things I want to address without overwhelming the doctor or myself, and without doing that thing where I make a careful list and then get to item three and suddenly feel like I’m overstaying my welcome or talking too much or whatever. I cannot tell you how many times I have gone to see a doctor with Very Specific Things To Discuss, and have decided in the moment that they are silly and I won’t bother the doctor with them. Even when I bring a written list with me, I still do this. 

(You might think that having grown up with a physician for a parent, and then marrying a physician would negate some of the awkwardness I feel when at the doctor. But no.) 

Since three seems to be the magic number, I think I have narrowed my Must Discuss List to three topics: 

  1. Fatigue. I am tired all the time. Like, more tired than in years past. (I feel like I’ve been chronically tired since at least 2012.) So tired that I see the effects of the tiredness in other areas of my life. Is this… The result of a medication I’m taking? A symptom of perimenopause? A deficiency of iron or vitamin D or something else? Because I am terrible at sleeping? Subset of the previous: it is because of my horrifically restless legs? Is the terrible sleeping a result of poor sleep hygiene? Or perimenopause? Or some lifestyle choice I am making? Is the tiredness (and/or terrible sleeping and/or restless legs) fixable? Or is this just my current phase of life (The Tired Phase) and I need to accept and lean into it? 
  2. Medication. I started taking anxiety medication in December 2023 after a series of escalating panic attacks. The medication has been very helpful. I think I am in a less anxious state now than I was then; is it time to try to discontinue the medication? If so, how do I do that? And what happens if I decide it was a terrible plan to discontinue it? Yes, 2023 was a wildly exciting and action-packed year which ended spiking my anxiety to new heights, but it’s not like I was NOT anxious before that. I am not opposed to taking medication when it is helpful, but I also don’t really want to take medication if I don’t need to.
  3. Weight. Due to some fairly significant weight gain over the past year, I am heavier than I have ever been in my life. Aside from not being pleasant in a variety of ways for a variety of reasons, I am wondering if I need to Be Worried. Is my weight gain a side effect of the aforementioned anxiety medication? A symptom of perimenopause? The result of too many nachos? Something else? Is it causing any problems I should be aware of, aside from the expected and unwelcome not-fitting-into-my-clothing and poor-self-esteem issues? (Like perhaps my extreme tiredness?) Beyond trying to eat less and move my body more, is there anything I should be doing?

You may notice that this very tidy list of three contains many, many subtopics. That feels a little like cheating. (I imagine myself telling the new doctor, “I want to discuss three health concerns with you!” and then bombarding her with restless legs! and perimenopause symptoms! and anxiety! and insomnia! as she crumples to the floor under the weight of my hypochondria.) (Yes, I do realize this is not how doctors work.)

You may also notice that “weight” is at the bottom of the list, in case three topics ends up feeling like too many topics with which to burden the doctor. (I know; I cannot stop thinking this way.) I put it at the bottom because it is the topic that, to me, seems to have the most obvious solution (eat less and move your body more), and also because it is the topic that I feel least comfortable bringing up. It’s such an uncomfortable topic! And possibly the doctor will bring it up anyway, without me having to say anything. 

I have a new, third fret: that I will inadvertently turn my New Patient Appointment into a Sick Visit. Why yes, this fret IS brought to you by two weeks of my family being sick plus waking up at four o’clock this morning with a terrible headache and a sore throat that feels worse than yesterday’s mildly scratchy throat and ear pain and a low-grade fever. 

What happens if I AM sick for my appointment? Is that… allowed? I feel like the “rules,” insofar as I (don’t) understand them are that you can’t be treated by a new physician until you have established with them as a patient. This is why I have been scrupulously healthy this year, because I would much rather go see my PCP than visit urgent care. 

If I AM sick for my appointment, then identifying/treating that illness probably jumps to the top of my list of concerns… but can I also address the other less-urgent topics?

Should I perhaps be badgering my husband with these questions instead of fretting about them on the internet? I mean, yes, but what is the internet for if not for airing ridiculous worries.

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Misery! Of the Optical Sort

Do you know the difference between these two bottles?

Eyes.JPG

The righthand bottle is plain old saline solution. It’s for rinsing and storing your contact lenses. The lefthand bottle is a special enzyme-cleaning solution for your contacts. You put it in a special case with your contacts and the case contains a neutralizing material that does the crucial neutralizing over many (six, I think) hours. You can see right up on the top of the bottle in big, bold letters that you should NOT put it in your eyes. If you are a contact-lenses wearer, you probably already know that. I have been wearing contacts since fourth grade so I DEFINITELY know that.

And yet, the other day, I removed my contacts from the case, put one lens on the tip of my finger, and instead of filling the lens with normal saline as I have EVERY DAY OF MY ADULT LIFE AND MUCH OF MY CHILDHOOD, I filled it with the enzyme cleaner instead. And, not noticing my HEINOUS ERROR, I put the enzyme-solution-filled lens in my eye. And then I died.

No, I didn’t die. But I was felled by immediate, searing pain. I literally collapsed to my knees, on my bathroom floor, in a very dramatic fashion.

I like to think this act of unfathomable stupidity was a test of my emergency-handling skills. Okay, I will admit that my immediate reaction was to crumple to the floor and screech loudly and wonder who in the hell was going to call 911 for me (I was alone in the house), which doesn’t bode well for fires or murderers.

But then my logical brain took over, and I started flushing my eye with lots of cold water. My eye refused to open because the last time it did, I tried to murder it. So I soaked a washcloth in water and pushed that up against my eye until it finally did let me open it a crack. Then more flushing until I was finally able to pry to contact out of my eye. More flushing still. Then I was able to google what a person was to do if she was so ridiculous as to put enzyme solution directly in her eye. Flush with water, is the answer. Contact your eye doctor if the pain and irritation remains after several hours.

PHEW.

Let us now look at a soothing hibiscus bush.

Hibiscus.JPG

Yesterday, there was a single blossom… today, many! Just like popcorn, where you wait and wait and wait, and then all of a sudden your bush is full! But of hibiscus, not popcorn! Which I don’t put on shrubbery anyway! This metaphor has gone awry!

Before and since the Solution Incident of ’18, my eyes have been bothering me for a different reason. I am going to guess “allergies,” given the fact that I also sneeze a lot.

Whatever the case, my eye are constantly red and itchy and uncomfortable. I am constantly rubbing them and trying not to rub them and wiping them with washcloths. In the morning, they are encrusted by… well, crust. It’s really delightful.

I have been self-medicating with over-the-counter antihistamines and allergy eyedrops. They work a teensy bit. The great and all-knowing internet suggests that my best recourse is to stop wearing makeup and contacts. Blah. I like wearing makeup. My face looks naked without at least mascara. And I like wearing contacts. It’s almost a necessity, in summer, because I need to wear sunglasses to protect my eyes against the solar glare. And I don’t have prescription sunglasses, so I can’t wear them unless I am wearing contacts.

Well, I will give up both. If I have to. But the goal here is to have eyes that a) can see and b) can do so without redness, itching, or total nakedness.

Nothing I am doing on my own (eyedrops, antihistamines, rubbing) is working. I think I need either a) a diagnosis and an actual treatment plan or b) an updated glasses prescription so I can get some sunglasses with prescription lenses. In either case, I need to find a new eye doctor.

You may choose to skip this ranty/boring part:

The last time we discussed my eye doctor, I was frustrated by insurance issues. (Which we ended up paying; to make a long story still unfortunately long, my husband and I both got a bill from our eye doctor for the exact same service. Our insurance was covering part of my visit, but not part of my husband’s. Our insurance claimed that my eye doctor was no longer a preferred provider, so they wouldn’t be covering charges. Turns out he WAS a preferred provider, but only became one a month or so after my husband’s visit [and a few weeks before MY visit, which means the insurance company covered part of my visit out of the kindness of their hearts] [he’d just joined a new practice; previous to that he was a preferred provider according to our insurance].) Anyway, we thought we got the insurance issues sorted out. But recently, my husband made an appointment to see the eye doctor and once he was there, in the waiting room, for his appointment, they informed him that our eye doctor is no longer a preferred provider under our insurance plan. SIGH. So we paid in full for covered services for my husband two years in a row. And now we all need to find a new eye doctor anyway.

End

I do not WANT to find a new eye doctor. I want my OLD eye doctor. And I want him to be covered by our insurance. Yes, yes, I know I am very fortunate to have eyes and a selection of eye doctors in the area AND insurance that covers eye stuff. I can still be grumpy about having to find an eye doctor.

You know what this means, right? Research, and then calls to the doctor to see if s/he is taking new patients. And then calls to my insurance provider to see if the doctor is covered. And then calls to the doctor to make an appointment. It sounds like only three calls, which I acknowledge is manageable if mentally TRYING, but let’s agree that it will actually require many, many more than three.

Let us now look at a charming and probably hypoallergenic baby deer that would totally be a preferred provider lookit his little spotties awwwwww.

Fawn 2

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Doctors and Patients, Part 3: I Just Need a Little More Time

When you go to the doctor, you want to get her undivided attention, right?

And you want her to address all of your concerns.

My last PCP (primary care physician) was like this. She would always let me get through my rambling explanation of what was wrong before starting an exam or asking me a question. And at the end of every appointment, she asked me if I had other questions or concerns.

Now, I know this is hard to do. Physicians are overbooked. They have no time. So to be calm and unrushed during an appointment is a true gift.

But I think that you can cultivate this type of treatment from your doctor.

First of all, when you make an appointment, have one specific reason for doing so. Don’t postpone appointments until 10 things are wrong.

If you tend to “save up” all your ailments and concerns and then unleash them all at once on your doctor… and if you do this every time you see her… then I’m guessing it will be harder to get the unhurried “I have all the time in the world” treatment.

Yes, I know it’s more expensive this way. And believe me – I hate going to the doctor and dealing with insurance just as much as the next guy.

But I truly believe this will help your physician do a better job… and it will help you get the best care she can possibly provide.

Now, if you do everything right and your doctor still tends to be more of the “rush rush rush” personality type, you may have to coach her a little to respond to your needs.

According to a New York Times article called “Contentious Relationships Between Doctors and Patients,” communicating your needs is key:

“Go to a doctor’s visit with written questions so you don’t forget to ask what’s important to you. If a doctor starts to rush out of the room, stop him or her by saying, ‘Doctor, I still have some questions.’ Patients who are open with their doctors about their feelings and fears will often get the same level of openness in return.”

I also highly recommend – whenever possible – taking an advocate with you to your appointments. This could be your mom, your spouse, your sister, your best friend. Someone who can listen in to what your doctor is saying… ask questions that you may not think of… and recall the doctor’s comments/suggestions once the appointment has ended.

When something scary is going on, my brain tends to freeze up. So I’ve found that having my husband with me ensures that I get all the right information.

If this is impossible, bring a notepad with you. Write down key information. Ask your doctor to repeat things and spell things for you. See if your doctor has any pamphlets or articles on your problem that you can take home.

When it comes down to it, your health is your responsibility. So make sure you don’t let a hurried physician prevent you from getting all the information you need.

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What say you, Internet? Any advice about making sure you get everything you need from your doctor during an appointment?