“She appears anxious. Has pressured speech.”
These words were written by a PA in my obgyn clinic at the VA after my last visit.
Let’s put that into context. The VA facility is a long way from my house, and I had an 11 am appointment. The day I left for that appointment, I ran into heavy street construction in my neighborhood, and got trapped on a side street. I had to make multiple, long detours to get to the main highway, ensuring that I was likely to be late. I called the clinic and was told that I had better make it by a certain time or else I’d have to reschedule.
This was an appointment I’d made because I had found some suspicious lumps on my lady parts.
Anxious. Really? About that? And about suddenly being caught in construction causing me to be late? As a military person, being punctual and respectful of other people’s time- especially at the overcrowded VA- are high priorities. The VA is increasingly busy, and so missing this appointment (for which you get a nasty gram) meant that I’d have to wait a while before I could be seen. Nobody likes waiting in limbo with suspicious lumps in their lady parts, wondering what the hell is going on. So of course I rushed, for both reasons.
On top of that, I’ve been dealing with severe pain as a result of complications from a recent surgery. The pain doesn’t respond to meds, makes it hard to sleep, and it’s been a cluster trying to deal with a surgeon who believes the pain is all in my head. His favorite fly swatter word is “hysterical.” The PA noted the pain, which that day was a 7 on a scale of 10- which any thinking person might acknowledge is pretty damned painful.
Oh hell no.
I drove like a madwoman to try to make the appointment time. I did make it, and we had our appointment. The upside is that what I had wasn’t dangerous, but I didn’t know that starting out. We never do.
Here’s my problem.
The PA in question didn’t bother to put “anxious” in context. She didn’t bother to ask me questions about “anxious,” in order to clarify what might have caused that- in other words, do some basic, respectful sleuthing to determine a life situation, which in this case was highly specific and TEMPORARY, in order to understand what might have caused a behavior. Being late, being caught in construction traffic, being in a lot of pain, almost missing an appointment might cause someone a little grief. THAT’S JUST LIFE.
As a rape survivor, I don’t like opening my legs up for inspection to anyone, PERIOD, unless it’s my BF. And in this case we’re talking about something that would scare any normal human being: weird lumps in very tender places. THAT’S JUST LIFE. And in context it both perfectly understandable and normal.
The other piece is “pressured speech.” That is a highly subjective and personal judgment. Anyone who has even the most basic of understandings of Jungian archetypes knows that there are some of us who are naturally high energy, enthusiastic. That’s a type, which occurs normally and naturally in personalities. I am one of those, and being energetic is my norm. That this PA may not share that energy does not give her the right to judge my energy level as “pressured.” Again, without putting this into context, and since these comments were listed under psychiatric, this is a setup for a gross misread by the next person who checks the notes.
Just as my boyfriend is my personality opposite, and is far more quiet and self-contained than I am, this PA’s natural way of being is my polar opposite. However that does not give her the right to misread, misjudge behaviors that to her, in her experience, appear pressured or anxious.
Herein lies the problem. These words can and typically are broadly misinterpreted by other health care professionals, and they are labels. In this case both are wrong and out of context. This is how our healthcare gets undermined- when someone decides that you are (anxious, annoyed, disturbed, fill in the blank here). While using the term “pressured speech” is objective, without context, and used with the term “anxious,” one could make the assumption that I’m troubled, out of control, and for heaven’s sake, in need of meds.
Each year some twelve million Americans are misdiagnosed, and this is one of the prime reasons why. Healthcare providers, given significant implicit and explicit power over the quality of care of their clients, can torpedo us with misguided comments, lack of basic research and simply wrong assumptions.
This is how we die. Because others who read those comments put their own misguided interpretations on them without interviewing us, without verifying, validating and clarifying. People are prescribed meds they often don’t need because of this kind of misinformation. This is how we get polypharmacy, which is the overmedication of individuals, most particularly those in my age bracket.
I had an ER nurse read my oxygenation numbers once, which that morning was at 100%, and dictate to me that I had to “increase my meds because I was anxious.” That morning I’d already run some 2400 steps and done 60 laps at my pool. No questions, just assumptions, and she didn’t bother to ask a single question about my lifestyle. I’m an athlete. Of course I’m oxygenated. My pulse is in the high 40s and low 50s. For a lot of these healthcare providers that’s a red flag because they’re not used to seeing a 65 year old woman in my kind of shape. So they want to throw pills at what they see are symptoms before asking some simple lifestyle questions.
This is how we die.
If we challenge, question or demand better healthcare we are labeled belligerent. You’re damned right I am belligerent. When we are faced with these kinds of failings among those we are expected to trust, and it’s clear we can’t, we have every right to be belligerent.
Because we now have to protect ourselves against mediocrity, bad assumptions and poor quality care.