Wednesday, January 30, 2013

Is my patient crazy? Negotiating Complications in patients



It has been a while since my last post. One of the reasons for this was that I was a victim of a Medical Error that became a Medical Complication.

I underwent an elective and routine oral surgery, wisdom teeth removal and 2 dental implants. Both procedures have a low risk of complication and most folks are back to their routine in a few days.  I expected to be one of them, I was not. 

As it turned out, I was one of the rare cases that developed an infection in my gums as a result of the bone graft necessary for the Oral Surgery. 

There were several distressing factors to my case:

  • I was in pain and depended upon medication to manage it for 19 days and antibiotics for almost a month.
  • I was angry at myself at choosing to have elective surgery knowing that there is always a chance of complications and not being properly prepared for this possibility.
  • The amount of time and energy it took to resolve this problem was absurd. It took almost 1 month as I had to diagnose myself with the help of Google and advice from other healthcare professionals.  
  • The most disturbing factor in my case was that my Oral Surgeon implied that I was crazy, instructed me to stop calling the office and suggested that I should go see an allergist.


I learned many things from this experience:

  • I have a greater appreciation for what patients go through. I can now relate to feeling helpless when your body turns against you and you depend on medications just to get through the day.
  • I also learned that pain meds mask the reason why you have pain and can make proper diagnosis difficult. When I went to my appointments I was on meds and didn’t feel that bad so my doctor did not get to witness me holding my jaw and wincing in pain praying that my meds took effect soon. Knowing what your medication does and discontinuing or change them can help to determine the cause of your problem. In my case my pain started 12 hours after I discontinued antibiotics. My pain decreased in half with antibiotics and anti-inflammatory meds. The pain was 85% resolved and I did not require pain meds when I was placed on the correct antibiotic.  The pain and need for antibiotic resolved completely after the abscess was drained and I finished my course of antibiotics. Therefore we deduced that I had an inflammatory problem that was caused by an infection.
  • When speaking with an attorney who represents doctors in cases of malpractice, I was told that in his experience surgeons are reluctant to ever admit that something went wrong with their surgery.  Some may say that this is an ego thing and in some cases maybe it is. I think that if surgeons bring to their consciousness the amount of things that can and do wrong in a surgery, they may be unable to operate.
  • In my career I have witnessed many patients who have been victims of complications and or medical errors and discarded by healthcare professionals. I believe there is frustration by doctor’s and others who are expected to know how to help these patients, and rather than admitting that they just don’t have an answer, they chose to dismiss the patient.


As a patient I would recommend the following:

  • Do your research. Search the internet for “complications of ________” and/or search your symptoms. See what comes up, disregard that which does not make sense or does not apply.  Consider and share with your healthcare provider the possible reasons for your problem. If they rule out a possibility that seems plausible to you, ask them to explain why they are ruling it out and how they can be so certain. I would have had a quicker resolution to my problem had I done this. Unfortunately, I choose to accept my surgeon’s word that “there was no possible way that I had an infection “without question.
  • Be honest with yourself.  Is there any way possible that your symptoms may be psychological in origin? I had to go through this process myself and list the reasons why my symptoms were not psychosomatic to justly discredit this possibility.
  • WRITE YOUR CONCERNS/QUESTIONS DOWN ON PAPER AND MAKE SURE THEY GET ADDRESSED DURING YOUR VISIT.  I made this mistake as well. I had my list in my head and got distracted as I became upset by my doctor’s behavior.
  • Find an ally. Get another opinion. I was referred by my surgeon to a dentist. Thankfully, this Dentist believed my story, and acted as a liaison between myself and the surgeon. Make sure that when you seek another professional ‘s opinion you are prepared for this visit by bringing all of your medical records and diagnostic tests. (PT’s and OT’s are often great allies).
  • Communicate effectively to your health care provider by being concise and fact oriented. Give examples; in my case, I informed my surgeon that this was the sickest I have ever been in my life and the longest time I had been on antibiotics and pain meds. I added that when I gave birth to my daughter I did so without drugs and took a total of 3 Tylenol postpartum.  I don’t enjoy nor have the time in my life to be sick and that while he is the expert in dentistry, I am the expert of me and I believe that something is wrong.
  • If you are having an elective or surgery do your research prior to your consultation, ask questions and make sure that you are prepared if circumstances do not turn out favorable.
  • Understand that not having the answers and support from your healthcare professional in addition to feeling sick is DRAINING. Do only what you can and manage your energy.
  • Get the word out to your doctors, friends and social media. It is an opportunity to get ideas from others as well as a venue to express yourself and share your story.


As a Professional I would recommend:

  • Provide your patient with the before mentioned list of patient recommendations.
  • Listen to the patient’s subjective history.  The answer or clues to why problem is occurring is usually there.
  • If you are unable to help your patient for whatever reason, it is your obligation to tell them and refer them to someone who may help. This is scary territory.  As a highly trained professional you are sometimes expected to know everything. I have a former patient who praises me to this day for admitting that I was unable to help her and referring her to someone who knew how to perform a technique that at the time I was not trained to perform.
  • Delicately discuss with your patient the possibility that their pain may be psychosomatic in nature and ask them to explain why they are sure it is not. If you are acting as a liaison with their doctor, you can share this information.  This is a very sensitive conversation, a suggested way to present it to your patient is the following; “you are experiencing some unusual symptoms and while they are real and legitimate, some people may feel that their origin is not physical, lets rule out not only the possible physical causes lets also rule out any possibility of an psychological cause”.  Ask them to list reasons way they are sure that their symptoms are physical in origin and ask them if they believe that there anything positive in going through what they are experiencing
  • Ask advice from your colleagues. Use LinkedIn or other social media.  For those of you who have taken courses with the Institute of Physical Art, there is an IPA Google group where therapists share information and ask for ideas about challenging patients. You can request to join at ipa-functional-manual-therapy@googlegroups.com