By Rod Moser, PA, PhD
There was another Emergency Room visit in our family this week. The other set of grandparents flew into town for our mutual granddaughter’s high school graduation and are staying with us for a few days. After enduring the typical high school graduation ceremony, watching about six hundred young men and women get their diplomas amid the cacophony of high-pitched screaming, cowbells, and ear-piercing air horns, we retreated to the quieter environment of a local restaurant. I have never been a big fan of noisy crowds, like sporting events, but this rowdy group nearly took my tinnitus to a new level. I was not the only who was feeling less than optimum.
Grandma #2, who prefers to be called by her chosen grandmother name, Mimi, is a vibrant woman in her mid-sixties. Mimi and her husband, Poppy, are both retired now, but Mimi never sits still long enough to gather dust. She is heavily into crafts of all types and has recently started her own homemade greeting card business. A few years ago, she had a surprise heart attack, but after some corrective cardiac surgery (a stint to widen one of her narrowed coronary arteries), she has done well. Like most of us who are in our sixties now, we tend to share our symptoms. We complain about our hearts, blood pressure, kidneys, backs, and joints. You mention a symptom, and we all can relate. I call this an “organ recital”.
Mimi was not feeling well. She was complaining of some unusual pain in her left jaw all week. She thought it was a dental problem, so she wanted to get it fixed before flying to the graduation. Her regular dentist had decided to retire as well, so she had to scramble to find a new one. After an exam, it was determined that her pain was not dental, but it could be a TMJ disorder in her jaw or a sinus infection, so she was given an antibiotic over the phone by her regular doctor. She was also complaining of pain in the left shoulder area, which she attributed to a muscle strain. It did not really occur to her that this pain could be something else. Like many people who feel unusual pain or symptoms, she downplayed it to us, and to herself.
Last night, while visiting with our other mutual grandchildren, she mentioned that her symptoms felt similar to the symptoms she experienced when she had her heart attack. Bingo! She was not having a dental problem, TMJ, sinusitis, or a shoulder strain. She was likely having referred cardiac pain. Many people do not realize that nerve pathways often cause pain to be felt in other areas, not just the heart. A classic example would be the heart attack victim who is constantly rubbing his left arm.
Our son called to tell us of her symptoms, so we insisted that she go to the emergency room immediately. Hearing this, many people will downplay symptoms even more.
“Oh, it’s not that bad. I don’t want to go to the ER. Just let me rest for a while and I will be fine.”
When a call to 911 was suggested, the downplaying became even more obvious, but she agreed to be driven to the emergency room. When you go by ambulance, you go to the front of the line. When you walk in the door to the emergency room and downplay your symptoms, you go to the back of the line. The triage nurse did not feel that she needed immediate care, but she was seen in about two hours. Fortunately, her electrocardiogram did not show a new heart attack, just the old one. Her blood tests did not show any elevations of cardiac enzymes, but her blood pressure was off of the chart. She was admitted for observation and will have some more extensive diagnostic heart studies in the morning. The entourage of worried family members blew in about 2 AM. They are all sleeping over at our house, much to the entertainment of our three dogs. I am confident that Mimi will be fine now that she is getting the proper care.
Every medical provider deals with patients who complain about everything – the over-complainer. When we start getting a litany of symptoms, we roll our eyes as we attempt to put these scattered diagnostic pieces into some type of order. It is a diagnostic jigsaw puzzle with too many random pieces on the table. And those pieces may be from totally different and unconnected puzzles.
When a patient denies, downplays, or de-emphasizes their symptoms, it is equally as challenging. Getting an accurate history from these down-players can be like pulling teeth. They will often purposefully leave out critical information because they have determined that those symptoms couldn’t possibly be important.
When a down-player or an over-complainer meets a medical provider who doesn’t listen, you can readily see how this combination would be errors waiting to happen.
I cannot emphasize how important it is to accurately communicate your symptoms to your medical provider: let a trained professional sort them out. Never minimalize your symptoms or make them sound worse than they actually are. If the medical provider doesn’t seem to listen, you need to MAKE them listen or find a different one that will listen.