Recently, I came across an amazing article in JAMA Neurology titled “It’s All In Your Head – Medicine’s Silent Epidemic”, written by @MattBurkeMD which really struck a chord with me. It was a beautiful and comprehensive article about the growing epidemic of doctors dismissing patients who present with unexplained symptoms by saying that it is all in the patients’ head. To be honest, I have had my own fair share of doctors who said those exact words to me too, either directly or indirectly. The fact that I am a doctor did not spare me from it, in fact, it probably had made matters worse.
The fact that I am a doctor did not spare me from it, in fact, it probably had made matters worse.
When I had multiple cardiorespiratory symptoms post-laparoscopic surgery in 2016, I was ‘investigated’ but was told that everything was ‘normal’. But, the symptoms persisted for over 2 years with varying degrees of severity. Each time it got to a point that I was severely limited in performing my daily activities, I would seek further medical opinion. One doctor after another told me ‘nothing’ can explain why I was having all those symptoms. One of them even said “You are okay, so please don’t come back again” and then proceeded with a discharge note that says “Patient reassured” with no further follow-ups provided.
As if that wasn’t bad enough, I was frequently treated like I have some sort of psychiatric disorder, malingering to be specific. Instead of trying to investigate further and rule out all organic causes of the symptoms, the doctors focussed on my ‘behaviour’ and gave advice like, “Try not to worry too much, will you?”. Instead of becoming curious when the symptoms worsened but the battery of tests showed ‘nothing’, one of the doctors said, “You are a doctor, so you must’ve put two and two together”, hinting that I might have made up all the symptoms. To say that I was frustrated after those experiences would be an understatement.
“You are a doctor, so you must’ve put two and two together”
Clueless doctor (2017)
After two arduous years, I finally met a team of doctors who were clear-headed enough to see the symptoms for what they were, instead of just being judgemental or dismissive. The doctors’ positive attitudes eventually helped them figure it all out. In retrospect, I must say that they were also brave enough to admit that a life-threatening condition had been missed by all the previous doctors, knowing full well what I was capable of doing given the circumstances. As it turned out, the diagnosis was so obvious. It was so unmistakable that I was left wondering how could so many doctors have missed it. I guess it was not just in my head after all.
Thankfully, I’m still alive to finally be able to tell my tale. Although I had some serious self-doubts as I write this, I have no doubt that letting it out would benefit me (by allowing me to move forward from the regrettable occurrences) and others. I don’t usually do this but I hope this post would allow healthcare professionals to be more aware of their attitudes and behaviours when interacting with patients who have unexplained symptoms. We (healthcare professionals) need to see these patients in a different light and change our opinions of them. We need to help those lost souls. Please don’t fail them as I was failed before.
Unbeknownst to them, I also hear my patients’ version of being on the other end of this (It’s all in your head) phrase and find myself constantly trying to repair the damage that these words can cause
Matthew J. Burke, MD, FRCPC
If you like this post, don’t forget to share it and #noitisnotinmyhead. Be sure to read Part 2 next week for my take on why healthcare professionals should think twice (or thrice) before saying those god-awful words. In the meantime, please leave me a comment if you have experienced something similar.