Sunday, March 30, 2014

Nervous About Going to the Doctor - A Patient's Story

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About a month ago, a reader contacted me after he found a post I had written about a sensitive physical exam. I will be telling his story over the course of two or three posts, with all identifying information and writing style changed, in the hopes that it might help others out there who are dealing with the same worries that he had. Here is his first email:

Hello Sir, 

Sorry, but I really don't know how to address you. I happened upon your blog while on the internet and I think I can tell you my medical problem because, well, you seem to be frank and... genuine. I guess I feel more comfortable communicating this way due to the fact that you are on your way to being a doctor... I don't know. I'm just really embarrassed.

Here's my issue: I have never had a physical exam by a medical doctor. I am 56 years old and I know this is not a good thing. My father and uncle had prostate cancer and I have been told repeatedly that I need to get a medical check-up, but it's just that I am very nervous and maybe afraid about the whole thing. I really don't know what to expect...

I am embarrassed to be unclothed in front of another person, even a doctor. I don't know what will happen, like what he will say or do - just a lot of stuff like that. I don't even really know what to ask you... I guess - have you learned anything about how to help a patient like me? I know I've got to do it, but I am really stressed out...


I wrote this in response to Thomas, but it could really go out to anyone who is dealing with similar thoughts, emotions, and feelings of fear and nervousness about going to the doctor. So, if you're reading this because you're nervous about going to the doctor, pretend it's addressed to you:

Hi Thomas,

Thank you for telling me about your situation. I think that your feelings of nervousness and even fear are quite natural, given the circumstances. I can see how someone with a family history of prostate cancer could be nervous about the idea of getting checked out, especially as you have never had a physical exam before. I think it's okay - even natural - to be nervous about this kind of thing. I also think that it might be easy to let that nervousness grow simply by imagining things to be worse than they are likely to be.

And you're right - I'm not a doctor yet. As such, I cannot give specific medical advice. However, you're also right that it will be good to get checked out in the near future. Even though I am not a doctor, I can offer my opinion on what might be the best "first step," given your feelings about going to the doctor. Before I do though, it might help to have things explained from the doctor's standpoint.

Doctors are trained to understand that getting unclothed for an examination can be very scary for patients. Most of us understand that this is not something that is easy for a patient to do. Sensitive examinations like this require a certain level of trust between the doctor and the patient. Most doctors establish this trust with their patients over years of visits, and so when sensitive examinations come up, it's not quite so scary. The patient trusts the doctor.

So, I think what might be a good idea for you would be to find a doctor and ask to meet with him or her (whichever you think you might feel most comfortable with) for a preliminary examination. You can request to not have a prostate exam done during the first visit. This way, you can have a chance to establish a relationship with the doctor, and he or she can get to know you a little better before moving on to the more sensitive examination at a later date. If you meet with the doctor and don't feel that you would be able to come to trust him or her, you could always look elsewhere for another doctor that you like better. Also, if you would prefer to speak with the physician over the phone as a first meeting, you could explain this to the nurse when you call the office for the first time. A good idea for where to get started might be to ask around among your friends for which doctor they see, and if they like their doctor. No need to tell your friends anything other than that you're looking to find a new doctor. Who knows - maybe one of your friends or relatives sees a great doctor with whom you'd get along really well!

The most important thing in all this is your health - both physically and emotionally. Any good doctor will want you to be healthy in both respects, and will not sacrifice one aspect for the other. I think it would be good for you to speak openly with whichever doctor you choose about your history and your reservations about having the rectal examination done. Any good doctor will be compassionate and understanding about what you're going through, and they should work with you about establishing trust.

Once that trust is established, I think you will find it much easier to contemplate going forward with the exam. Trusting your physician enough to form a partnership with him or her in the preservation of your health will go a long way toward helping you with your nervousness. I respect you very much for taking the time to write to me about how you're feeling, and your doctor will respect you as well. I think it's very admirable that you are considering the necessary steps for the sake of your health, even though you might be feeling scared and nervous. When you do end up choosing a doctor that you trust, I think you may eventually come to find him or her to be a source of support, rather than a source of nervousness. He or she will help you come up with a good plan so that you and your doctor - together - can deal effectively with any health issues you may have. And who knows - maybe you'll get a clean bill of health and totally set your mind at ease!

Above all, remember that all doctors start out like me - someone who wants to do everything they can to help people like you be healthy. We want to support you, and we want you to feel safe as we do so.

Please don't hesitate to write back if you have anything else you'd like to say, if you have any more questions, or if there's anything else that I can do to help. Even though we don't know each other, I will always take the time out to do what I can.



Thomas replied a few days later with a thankful and succinct response. I thought this would probably be the last I'd hear from him:

Mr. Justin,

I want to thank you sincerely for taking the time to answer my inquiry. Your explanations and insights really did help me. I am going to follow your advice and move in the direction of seeking a physician I can trust. You will be a very good doctor... Keep to your studies. You have a way of connecting with respect and understanding. Best regards - fortunate are those who will one day call you their doctor.


A month went by, during which time I thought about Thomas several times, but like I said, I never really expected to hear back from him. I just hoped everything went well. Earlier this evening, I was surprised to have the following letter pop up in my inbox:

Hello Mr. Justin,

This is Thomas here. A while back I emailed you about my concerns over having my first physical exam. You gave me a very informative and what I think was a genuine response. I am so glad I confided in you because your words gave me the confidence to find a doctor and have my first physical exam. 

I will readily admit that I was very anxious, and I am sure it was evident to my physician. However, he was exactly as you said a doctor should be when examining a nervous patient. He reassured me, and was courteous and understanding. You are wise beyond your years. You had told me that patients often imagine the physical exam to be worse than it is... That was me to a T, but now I am much more at ease now and I have been back twice to complete the physical exam. 

My doctor is going to take good care of me - certain tests for the prostate because of family history and lab work which he will analyze for various things... Well, anyway, I am sure you know all of this as you are a medical student, but I just want to say that you must keep the compassion and sensitivity that you have for people like me. 

Honestly, you really helped me tremendously, and you will be a fine doctor. I know this... You have compassion. Thank you, and do good in your studies.



I must admit, in the midst of the stress and occasional discouragement of studying for Step 1 and the next domain exam, it felt incredible to hear about Thomas' experience. It's great to have played a small part in helping someone. It feels pretty rare that we med students get to take a break from learning and actually do something. Helping people is one of the biggest reasons we started down this road in the first place, and it can be easy to lose sight of that behind the thousands and thousands of practice questions and textbook pages...

To any potential patients out there who are struggling with nervousness about going to see a doctor, I would recommend that you take heart from Thomas' experience and try to find a doctor with whom you're comfortable. After all, nearly every doctor was once a lowly med student just yearning to help people, so who knows - it might not be as bad as you think.

1 comment:

Susan said...

It truly was so wonderful to read Thomas' first message to you and then to read his follow-up comments! Good job Thomas! And Justin, you will be a fantastic doctor. Your great desire to help people is really evident and that will show to your patients, too. I'm sure his response must have energized you in the midst of all your long hours of work!

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