Posted by: Kate | March 30, 2009

Does Doctor-Patient Confidentiality Mean he Can’t Tell if I Pinch him?

The neverending saga of my medical annoyances – and that’s exactly what they are, I don’t have any life-threatening, debilitating sorts of problems, just a series of things that slowly erode one’s ability to maintain much faith in the field of medicine – continued last week, when I went to my first appointment with a new neurologist.

This is the third new neurologist I’ve seen in the past three years; I think he’s the sixth I’ve seen altogether.  The cycle has become stale and predictable: after a certain period of time, my primary care physician becomes uncomfortable at the idea that I have two or three migraines a week but have never found a preventative medication that is effective.  For a long time, I was on Vicodin for them, though I took myself off of that a few months ago because I was starting to throw up about an hour after taking it (and throwing up does not help the headache).  I think my body just build up enough of a tolerance that it stopped working well, and then just decided to reject this medication rather than hanging onto something that wasn’t working anyway.  I don’t know, really, but the point is, the migraines are intense and painful, as though I have constant brain-freeze (some of you call it ice cream headache) for several hours, mostly right behind my forehead.

So I switched back to Fioricet, a combination of acetaminophen, caffeine and a barbiturate, while I waited for this appointment with the new guy.  It didn’t work especially well for the pain, but it did get rid of the weird visual stuff that came along for the ride, and the nausea.  The down-side of it is, I can never predict how it’s going to affect me; sometimes that caffeine kicks in first and I’m awake (and unhappy) for hours, and other times the barbiturate kicks in first and I’m falling asleep on the walk between the living room and the kitchen.

On Thursday, I packed lunches for myself and Jacob and we got on the road; this appointment was two hours away, at the Dartmouth Medical Center in Lebanon, NH.  Big, impressive name, yippee.  I had told my PCP that I expected them to ask me why I was there, what was her reason for referral.  And she said, very flippantly and in a manner guaranteed to just set my teeth on edge, “Oh, I think they’ll be able to cure your headaches.”  Really?  Do you think they’ll have some new medication, or a new treatment protocol, that you haven’t heard about before?  “Oh, I don’t know, I just think they’ll be able to cure them.”  Great, thanks, glad I’m going into this with a clear game plan.

We arrived on time for the appointment, and wandered through the maze of the hospital to get to the Neurology wing.  I brought my Excel spreadsheet, on which I’ve kept track of every medication, both preventative and abortive, that I have tried for migraines over the past 16 years.  There are 28 items on that list, and he started me on two new ones.  Does 30 seem like an absurdly high number to anyone else?

The appointment was so predictable as to be trite.  He did a quick, cursory physical examination, in which he learned that my balance is good, I don’t have big numb spots on my skin, my sense of smell works, and I have under-responsive reflexes in my knees.  He asked a number of perfunctory, rote sorts of questions, about my history and symptoms.  And then he donned the Cloak of Self-Congratulation, spoke about all of the previous doctors I had seen as though their IQ’s were in the double-digits and their parentage was dubious, and announced a new combination of medications for me to try.

I didn’t groan out loud, but I sure did inside my head.  Every. Single. Neurologist. has followed that same script, and so far, none of their new tricks have worked.  I would love it if they did work, really; right now, I can afford to take a day to mostly lie down and keep things quiet untli the headache passes, but assuming I will someday get a job again, I won’t have that luxury.  I don’t want to be cured, because I think that’s an unrealistic goal.  I just want to feel like I’m managing them well enough.

So, we’ll see.  I can’t start on the new medications until tonight – and they’re only to be taken when I’m actually having a headache, so I’m not sure exactly when I’ll try them – because our health insurance is such that we can only get prescription coverage through one pharmacy on the whole planet.  Which is only open limited hours during school days, is closed all summer and winter break, and normally stocks only the typical college-student pharmacopeia of antibiotics and birth control.  Unusual medications, like, say, everything I’m on, takes at least two days for them to order and prepare.

And I’m left frustrated, because the neurologist’s parting shot to me was, “You know, I don’t expect to cure your headaches altogether.  My goal here is to get them down to the point where you’re having two headaches a week, and those will be manageable with the right medication.”  Um…. hi.  I already “only” get two headaches a week, and can manage them with the right medication, at least well enough to function in the rest of my life.

Sometimes optimism is just a talent I don’t possess.



  1. Ugh. That sounds like so many doctors’ appointments I’ve had with neurologists.

    Then there was the doctor I saw in college about my then-undiagnosed headaches. When I said that maybe they were migraines, he said, “No, migraines don’t feel like that.” It took another seven years for a correct diagnosis. I wanted to kick him at the time.

  2. That appointment would have given me a headache…

  3. Ouch. Well, you’re better than me; I would have used “punch” in the title of this post.

    What a twerp. I wonder if the Cloak of Self-Congratulation is handed out to all fancy doctors (ie., neuros, thoracic surgeons, etc.) upon receipt of their certifications. Having dealt with quite a few of those in the last few years through various family members’ medical needs, I have to think it must be.

    (Disclaimer: this excludes most, if not all, Nurse Practitioners and many, if not most, family practitioners.)

  4. Despite history, it never ceases to amaze me when doctors pull this crap. I am constantly reminding my friends who are doctors NOT to do this. I’m like a broken record.

    Sorry, dear. Here’s hoping that his meds magically work and if not, that he’s not such an ass-hat wearing douche next time.

  5. Kate maybe it’s time to try something more alternative. I don’t know much about migraines other than they’re awful and debilitating but it seems that conventional medicine just resorts to drugs. Acupuncture seems to offer some success.

  6. Ugh. That makes me angry! I always think there must be some special keywords that we could use to break through a doctor’s script. Maybe that book _How Doctors Think_ has the magical password. Good luck.

  7. how about getting acupuncture or something naturalistic? This seems a bit crazy. I know with my last one it lasted 15 days and was miserable I am regretting the next because they seem to be getting worse each time.

  8. I just wanted to tell you that I thought of you just now. My husband was helping my son with his homework, working on writing his alphabet, when I heard him say, “Show me a Perfect J”.

    Good thoughts for manageable migraines headed your way.

  9. After finally getting rid of mine after four days (and I’m waiting for it to come back).. I can totally sympathize.

    Is there a local massage school by you? I tried massage before going on beta blockers and found that it helped quite a bit (I just couldn’t afford to keep it up every week)

  10. Hmmm… I was thinking maybe you should’ve just posted this on Wednesday, for Madhouse… medical degrees and big names by no means exempt one from fool status. And HOW FRUSTRATING. AND ANNOYING. for you.

  11. […] I know now!  Monday was the first really bad migraine since the new-neurologist appointment.  I’d had one, which I would consider moderate compared to many, on Thursday evening but […]

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