Why my best friend is asking me about my Doctor

[Akasa]

My best friend has been in the ER 3 times recently, once with a kidney infection that landed her in the hospital, once with a broken rib, and once with potassium levels so low she was passing out regularly without a clue as to why. What does her doctor do? Try to refer her to a psychiatrist because she's been in the ER 3 times recently so there must be something wrong with her psychologically.

[Zellie Crescent]

That's fucked up, he should be reported. Doctors are supposed to help people not tell them there's something wrong with their brain.

[LillFilly]

There are some quacks out there! Like my boyfriend's mother who complained to her doctor about knee pain, couldn't get a referral to a specialist, paid for specialist out-of-pocket, came back to doctor with x-rays showing severe knee degeneration that required surgery, and yet STILL being told by said doctor "It's all in your head" and him attempting to put her on some type of anti-psychosis meds!

Your friend needs a new doctor stat! Him implying that she's malingering / crazy can really hurt her getting treatment in the future.

[42_42_42]

None of those ER trips have anything to do with psych problems. WTF!

[Seshat]

That's fucked up, he should be reported. Doctors are supposed to help people not tell them there's something wrong with their brain.

I do have something wrong with my brain, but I know what you meant.

Hypochondria and Munchausen's Syndrome are actually very real diseases, and need/deserve to be treated as such. My husband knows someone with hypochondria, and he has to work very hard with both his family doctor and his psychiatrist to keep it under control.

His family doctor has become quite patient with 'I'm feeling <blah>, is that normal?' and has learned how to reassure the hypochondria-anxiety reaction.

In this particular case, I suspect the doctor was concerned about the possibility of Munchausen's: though I can't imagine how a person can create a kidney infection or low potassium levels. The broken rib, however, could easily have been a Munchausen's presentation.

That said, there are ways to diagnose the possibility of either hypochondria or Munchausen's that don't make the patient feel like you're saying 'it's all in your head, go away little woman'.

.... and I say this as a fibromyalgia patient. Despite various pieces of physical evidence that have shown up, some doctors DO still believe it's a personality disorder in the hypochondria/Munchausen's cluster.
It's actually looking like a disorder in the pain receptors, complicated by other stuff going on elsewhere in the body. So treating us as if we're in the hypochondria cluster is not going to do us any good at all. (And shows that the doctor hasn't kept up with his journals.)

Er. Detour there.

Anyway: I can see the doctor's reasoning, even if I think it a bit faulty. I suspect the way the doctor presented it was .. hm. Less than tactful. And I firmly believe that there are a lot of things which (some) doctors treat with a patronising 'it's all in your head' that should be handled vastly differently.

[Sapphire Silk]

In this particular case, I suspect the doctor was concerned about the possibility of Munchausen's: though I can't imagine how a person can create a kidney infection or low potassium levels. The broken rib, however, could easily have been a Munchausen's presentation.

Hmm. A kidney infection would be hard to give oneself. A UTI I can see. Pyleonephritis? Harder (though not impossible).

Low potassum levels can be easily induced with diuretics (water pills) that are not potassium sparing.

However, the evidence for a pysch disorder here is very thing. 3 incidents in short order do not Munchausen make. There is a whole manipulation component to this . . . the Munchausen patient gets something out of the illness. That's hard to tell with 3 ER visits for such separate and easily treatable problems. Munchausen patients want sympathy; those problems are too short lived and easily resolved.

[QUOTE=Seshat;912478.... and I say this as a fibromyalgia patient. Despite various pieces of physical evidence that have shown up, some doctors DO still believe it's a personality disorder in the hypochondria/Munchausen's cluster.[/QUOTE]

I had to listen to two doctors discuss this very thing in the hospital one day when I was doing visits on our hospice patients who were in the hospital (they were not talking about my patient). The one doc was bmg'ing that his fibro patient needed to see a pyschiatrist, not be in the hospital for her fibro pain.

[Geek King]

I had to listen to two doctors discuss this very thing in the hospital one day when I was doing visits on our hospice patients who were in the hospital (they were not talking about my patient). The one doc was bmg'ing that his fibro patient needed to see a pyschiatrist, not be in the hospital for her fibro pain.

On the other hand, I can kind of understand things from a doctor's point of view after reading some of the blogs. Fibro seems to be a default diagnosis when the a doctor can't find an obvious answer. Particularly considering the blog posts I've wandered accross where a fibro patient was finally diagnosed with something else that presents with the same symptoms after months or even years of treating for fibro.

I'm not a medical professional, but reading what seems to be going on in the field right now, I'd probably at least look into alternate explanations for a fibro patient who wasn't responding to treatments, too. Mis- or Over-diagnosis causes issues for both those who actually have the issue, and those who are not getting treated for the correct issue.