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Say 'Aaah' | Doctor Files

An Exam Room Ally Should Help, Not Hinder

October 23, 2000|Claire Panosian Dunavan | Claire Panosian Dunavan is an internal medicine and infectious diseases specialist practicing at UCLA Medical Center

A trip to the doctor's office. As children, we dreaded it. As adults, we don't exactly relish it. So why not enlist a friend or relative for companionship, moral support, another set of eyes and ears? No one who's ever faced illness could argue with the emotional comfort of an ally in the exam room. There are, however, practical considerations--pro and con.

Earlier this month, I saw a middle-aged woman I'll call "Helen." Having suffered for years with a hacking cough, she was recently diagnosed with atypical (noncontagious) tuberculosis. Another specialist had already prescribed a year's worth of antibiotics likely to cure her infection. Even before starting treatment, Helen was fretting night and day about the drug's possible effects on her sensitive stomach. Helen's husband, "Irwin," joined us after I completed her physical exam. Although he said little, I could tell Irwin was listening carefully.

Together, we agreed on a master plan: first, a couple more tests, then a three-month trial of treatment. I believe Irwin's presence gave Helen the confidence to proceed. His presence also gave me confidence that, down the road, there would be someone to reiterate the plan and help Helen monitor adverse reactions. All the while, Irwin never drew undue attention to himself. Helen--not he--was the patient. I hope he'll join her for her next visit.

Another recent patient, "Terry," a bubbly, out-of-town college student who has seen me for two years, illustrates a different patient-family dynamic. Despite receiving effective treatment for an intestinal parasite she picked up overseas, she's still bothered with periodic cramps, gas and diarrhea. As the youngest in her family--and no doubt a favorite--I'm sure her medical saga has been a major topic of conversation within the clan.

On this visit, Terry brought her uncle. A few months back, it was her mom. Before that, her sister sent in a list of questions. Looking back, each time I've repeated the same basic facts to someone else. It may help Terry to share her illness with those near and dear, but visits with her have begun to feel like family social events. Plus, with all the questions from family members, Terry's not getting my full attention. The next time she calls for an appointment, I'm going to ask her to come alone.

And then there are instances when I really wish a well-meaning friend or relative would accompany a patient, but the patient opts not to include them. "Alicia," an aspiring actress, first came to my attention when her father called me from another state. He wanted Alicia seen for a desperate skin itch resulting in open sores on her arms and legs.

When I met Alicia, I sensed something was wrong. Slim as the model Kate Moss, charming (if a bit over-animated), it eventually dawned on me that her late-night lifestyle included illicit drugs. She didn't deny it--only disagreed with my conclusion that the drugs were harming her and producing sensations that caused her to pick and gouge her skin. Needless to say, doctors don't disclose medical confidences to parents about their adult children--even if the parent is footing the bills.

The next time Alicia's father called, I could only hint. I can't discuss details but skin parasites are not her problem, I said first. Then, edging a little further, I added: "Why don't you come out and see for yourself? Or better yet, ask Alicia if you can join us for her next appointment." Alas, it was my last conversation with either of them.

For the majority of patients who merely need care, not confrontation, what about the idea of bringing a medical person as a companion to the doctor's office? Usually, I'm all for it because it makes my job easier. But there's a downside when doctor visits turn into group chats instead of directed conversations between doctor and patients.

Not long ago, I learned this lesson firsthand when my husband underwent hip surgery. Although his orthopedist spent ample time with us, for much of our meeting he talked with me. During subsequent appointments, I sat strategically to the side. Still, the doctor-patient dynamic was off. Eventually, I realized, with some humility, I really wasn't needed at all. Since then, according to my husband, the visits have gone great.

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Claire Panosian Dunavan is an internal medicine and infectious diseases specialist practicing at UCLA Medical Center. She can be reached at drclairep@aol.com. The Doctor Files runs the fourth Monday of every month.

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