Doctor to Patient:Your Symptoms Are In Your Head

When medical professionals, whether primary care or specialists, cannot figure out a diagnosis and all standard diagnostic tests are normal, two things occur.  The patient will be asked if they have a counselor and then, a prescription for either an anti- depressant or anxiety medication is given.  The patient leaves  the room still experiencing the symptoms and wondering if they might be mentally off.  They either have to wait to get sicker or  search themselves for an answer.  It takes courage and strength to know your symptoms are not psychosomatic.

Unusual?  A rare occurrence? Unfortunately, it is not. I know because it happened to me!  I was told my reactions to a class of medications was in my head and I needed to take an anti- depressant to get over it.  I didn’t take the anti -depressant and insisted that I keep trying different medications.

I was so frustrated with my primary care, I began thinking I needed to change practices.  On a follow up visit, my primary came into the room and apologized for not believing me. She told me in the last few weeks, several of her patients were having the same difficulty with medications.

Many of my clients use my services to help them find a doctor/NP who will listen to them and find answers. Some say, “Can you find me a Dr. House?”

I wanted to share two client stories with the experience of being told:                                                         ” it is in your head.”

Sara began to have symptoms of abdominal pressure and difficulty taking a deep inhale.  She had fatigue and  weight loss.  She saw her primary who did lab and radiology tests. All tests results were normal.  As her symptoms progressed, she was sent to multiple specialists, both traditional and alternative, who did their tests, all with normal results.  She continued to decline and began searching the internet for any specialist who might actually listen to her symptoms.

Her breathing difficulties increased and she was having trouble sleeping.  After seeing a pulmonologist, she was told and his written note indicated, she was in need of counseling.  Each time she saw someone, her spirits would dip.  She spent several nights at the ER with some relief but no understanding of the cause.

Finally she saw a  gastroenterologist ,who I believe out of frustration ordered a specific diagnostic test.  The result was positive.  She was told later by the doctor, the test had to be stopped while she was taking it because the results were so high and had never been seen before.  She was given medication and is feeling better. It took over a year.

The other client did not do as well.  Tom went to the doctor for a variety of symptoms including stomach pain, weight loss and fatigue.  He had an active life but found he didn’t have the energy to participate in his normal exercise routine.  His primary did a series of tests and radiological exams.  The labs were normal and the ultrasound showed a gall stone.  He had surgery.

After the surgery, his symptoms remained past the usual recovery period.  He returned to the doctor.  More lab and radiology tests and normal results.  His doctor  said he was depressed, prescribed several medications  When his symptoms did not improve, he was referred to a psychiatrist.

The psychiatrist told Tom, he was not depressed, he was sick.  He referred him to another doctor.  This doctor found the cause of the symptoms: cancer.

I don’t know when medical professionals started using depression as the catch all for an inability to find a diagnosis.  It is true that sometimes,patients are depressed and present with a variety of vague symptoms.  However, it has become the easy way out.  What also occurs is a patient then gets labeled as a frequent flier or worse drug seeker.

Having been in practice, I know how difficult it can be when diagnosis does not come easily.  Insurance companies can balk at paying for specific tests making it more difficult to reach a conclusion.  I had to train myself  NOT to think it was in the person’s head if I couldn’t find an answer.   I learned to respect and support my patient’s search for answers.