How not to treat patients.

I’ve been having small seizures for a couple of years now. I call them “seizures,” but I really don’t know what they are. My head jerks back while, simultaneously, a point of light fills my entire vision, temporarily blinding me. I feel briefly stunned, and that’s that. It only happens every few weeks, and lasts for no more than a second. It’s not painful, frightening, or even problematic. Now that I’ve gotten used to the phenomenon, it’s merely strange.

After a few months of this I went to a neurologist. He had no idea what was going on, and was just useless. Last fall I saw my optometrist, who ran some tests on me and determined that whatever the problem is, it’s not in my eyes — it’d have to be in the brain. He set me up with an area neuro-ophthalmologist, who set me up for an appointment in the distant future, which came to pass a couple of weeks ago. I will call this doctor “Dr. Smith.”

Upon my arrival at 8am, the assistants to Dr. Smith did a great deal prep work, giving me a series of eye tests, some of which I’ve had during routine eye exams, others of which were totally new to me. I sweated over the peripheral vision test, as always, taking it as a personal challenge to correctly identify the appearance every single point of light and not generate a single false positive. (I put so much thought and effort into this process that I actually determined how to game the system, only to discover that the software that runs the device accounts for the false-positives that result from people attempting to do just that.) Eventually, tests completed, one of Dr. Smith’s assistants issued me a warning. “He’s a little strange,” he said, “but he’s really good at what he does.”

After sitting in the examination room for five or ten minutes, in rushed a short, balding Jewish New Yorker. He wore the requisite white coat and, in one hand, clutched a small tape recorder. After the briefest of introductions, he lifted the tape recorder to his mouth while looking at my test results and declared: “Subject Waldo jay-aye-cue-you-eye-tee-aych.” I was a little jarred, but he regained eye contact and asked me to describe what the problem was.

“Well,” I said, “I’ve been having episodes of, like, blindness, I guess.”

He lifted the tape recorder to his lips again.

“Patient complains of quote having episodes of like blindness I guess endquote.”

He looked at me again. I paused, confused by the interruption and jarred by having my own words repeated with my verbal laziness so strongly accentuated.

“Blindness?”

“Yeah. A point of light appears and, in…um…a second or so, it fills my entire vision and I’m, well…blinded.”

“Quote a point of light appears and in um a second or so it fills my entire vision and I’m well blinded endquote.”

Again with the making fun of me, again with the incredulous tone. I was getting a little annoyed.

“And I don’t know if this is related, but I’ve getting a twitchy face about as often for the past couple of years, too. But everybody has twitches, right?”

“Quote I don’t know if this is related, but I’ve been getting a twitchy face about as often for the past couple of years endquote. Patient asks if everybody has twitches. No.

Our conversation, if you can call it that, continued like this. He asked only the briefest of questions, each of which consisted of just a word or two of what I’d just said, repeated back to me with the rising intonation that indicates a question. At no point did he talk to me — he’d just speak a few words at me and parrot back my response in the most insulting possible manner. My questions were repeated into the tape recorder and answered in a word or two, also into the tape recorder, or met with another question. If I had not been assured that he’s the best neuro-opthamologist in the area, I suspect I would have grabbed the tape recorder from him and told it what my symptoms are. Dr. Smith himself seemed wholly unnecessary to this transaction; I certainly got the sense that he saw me as the useless one in the trio.

After being sent for some more tests, and another round of discussions with the tape recorder, finally we had a conversation of approximately 60 seconds. He’d concluded that, in all likelihood, this is not something that he can diagnose. There was a small chance that it could be something serious that an MRI would pick up, but there would be nothing that could be done for me — a tumor of the optic chiasm, which would likely be malignant in somebody of my age, leaves doctors talking about the “debilitating neurologic deficits” that accompany treatment and emphasizing “quality of life”, so it’s basically terminal.

So Dr. Smith said that I have two options. I could have a round of MRIs, but if anything was found, I probably wouldn’t want to know about it. Or I could not, since, in all likelihood, my seizure-blindness episodes can’t be diagnosed. I chose not to have an MRI, and that was when I was free to leave.

I read in Malcolm Gladwell’s “Blink” that the doctors most likely to be sued for malpractice are not the ones who make mistakes. They’re the ones who are the least friendly to patients. People don’t want to sue people that they like, they want to sue the people that they don’t like — those are the ones that we’re inclined to see as at fault. It would take a great deal for me to ever want to sue my physician, who has been my doctor since I was a kid, or my optometrist, whose father I started seeing as a kid. Dr. Smith? If Gladwell’s hypothesis is correct, that guy is a malpractice suit waiting to happen.

I’m not worried. If my worst health problem is that I have a fun little blinky thing and a twitchy face every few weeks, I figure I’m in pretty good shape. There are much greater odds of any number of horrible things happening to me than the odds of my having a tumor or something. Whatever those odds, though, they’re a great deal better than the odds of my ever going back to that guy again. What a maroon.

Published by Waldo Jaquith

Waldo Jaquith (JAKE-with) is an open government technologist who lives near Char­lottes­­ville, VA, USA. more »

8 replies on “How not to treat patients.”

  1. Waldo,
    I am sincerely sorry to read this. I would encourage you to find other doctors who you can find a mutual respect with. They are out there, though hard to find. This is no small deal my friend. This could happen to you while driving. Two ladies in my life suffer from seizures. Both have had bad car crashes as a result. One had surgery and her life is back on track-no seizures since. The other still suffers and cannot drive, she is 32 and on SSI. Please look for answers and treatment. You are in my prayers.
    Kilo

  2. I can sympathize with you having seen what has happened with Mark. Some doctors are just unbelievable and wonder why you get upset. Fortunately I’ve been very lucky over the years in locating some really awesome doctors. (Unfortunately, no neuro-opthamalogist though–Sorry!) As a matter of fact, Mark is now going to one of them.

    This doctor has been a patient before–having had non-Hodgkins Lymphoma at 18 and almost every test known to man, I think. He spends time with his patients and discusses common interests (ours is gardening). After talking to Mark for only a little while, my doctor told me that Mark’s one doctor abused him as a patient and the other is illegally trying to obtain funds for copies of medical reports. We knew that–but it’s nice to hear a medical professional confirm it for you. : )

    So, keep looking and know that help is out there. In the meantime, I’ll have you put on my mom’s prayer list.

    Lisa

  3. For years I have had fainting episodes. Peripheral visonon goes, followed by tunnel vison, followed by gray-out, and heart palpitations. They occur after sudden changes in temperature, such as walking from AC into sweltering heat, or vice versa. They also occur one to two hours after vigourous exercise. Turns out it is a non-threatening heart condition related to some arcane blood chemistry. The onset gives ample warning, so driving isn’t an issue. Despite this my life has been entirely normal, other than the fact that I can’t get health isurance on account of having a “chronic condition”, never mind that there is no treatment and no treatment costs. All I can say to you, is that I hope your luck is as good as mine.

    I also had, at one time, terrible, vomit inducing, debilitating migraines, also resulting in near blindness, as well as incapacitation for up to four hours. I was fortunate and found a complete cure for these: they stopped entirely when I got divorced. I wouldn’t wish that luck on anyone.

    It might be nothing, it might go away, it might be serious. Good luck, whatever.

  4. I think what I’m going to do is just not worry unless my symptoms change. (“Dr. Smith” made clear that, should there be such a change, I should get right back into his office.) If these happen more often, or with more severity, then I’ll get an MRI.

    But, to emphasize again, three doctors have made clear to me now that this is probably just a weird tic not to worry about, and so I really and truly don’t worry about this. It’s not something that often crosses my mind or troubles me. My interest in posting this is really more about this doctor’s bizarre behavior (which people have told me since is rather common) than my weird little flashy thing.

  5. That’s really interesting, anonymous. I’m convinced that most people have some kind of a weird medical tic like this, something that is so fundamental to their lives that they don’t think of it as a “condition” — it’s just who you are.

  6. Waldo, I wonder if you would benefit from chiropractic and/or cranio-sacral therapy? Have you looked into these at all?

  7. You have to stay on top of these things, Waldo. They happen for a reason. Hopefully it’s not consequential, but there’s a great deal of benefit to eliminating the scary stuff as possibilities. Right now you have symptoms without a diagnosis. Keep after it until you have the diagnosis. This is what you’d advise a dear friend. In the unusual ephemeral world of blogging, you have a lot of friends who would advise you to do the same thing. Sorry you had a bad experience.

  8. Sounds like the “House M.D.” phenomena grows daily…

    So much for bedside manner. Might want to get a second opinion somewhere else (could be something pressing on the optical nerve).

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