Tuesday, August 24, 2010

In Reporting Symptoms, Don’t Patients Know Best?


"There is a sensibility among some old-school clinicians that they have a better sense of their patients' experience than patients do themselves," Dr. Basch said. "But doctors and nurses bring their own biases to the evaluation. They might say, 'Mrs. Smith always exaggerates her fatigue — she says 9, but I rate it a 6.' "

Three clinicians asked to rate the same patient's nausea will often give three different scores, he said.

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As proven by my own experience.  A series of doctors downplayed my reports of poor sleep, some with condescending comments like "sometimes when we think we are awake, we are actually asleep".  Uh, yeah, I think I'm sitting in the living room knitting at 3 AM, but I'm actually asleep in my bedroom, and that finished scarf on the coffee table was put there by the fairies.  Yuh-huh.  One of us is hallucinating, and it ain't me.

Then I got to the sleeping pill clinical trial where they gave me a sleep diary to fill out and the doctor actually looked it over instead of tossing it aside.  He had 30 days of "went to bed at midnight, still awake at 5 AM, slept 5-7 AM, then woke up and couldn't get back to sleep."  Consistently.  I'd rated my insomnia as "moderate", since I was getting *some* sleep.  He upgraded it to "severe" because I was getting 2 hours a night and it took till 5 or 6 AM to fall asleep.  So much for "this patient always exaggerates", huh?

One of the other doctors later explained that he didn't need to give me a sleeping pill, because I was already spending 18 hours a day in bed.  That "in bed" and "asleep" are two different things never crossed his mind.  Nor did he understand the difference between quantity and quality of sleep.

Another argued that there was no need for a sleep study to prove how little sleep I was getting, because sleep studies are only ordered for sleep apnea, and I said I don't snore.  Noooooo, what I said was that I don't know if I snore, because I sleep alone and had for years.  Really, though, what he meant was, if we order a sleep study and it proves you're telling the truth about only getting 2 hours of sleep, then we'll have to accept as truth all the other symptoms we're currently dismissing because we think you're exaggerating.  Much easier to refuse to order it and write "patient is depressed" in the medical records.



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