Lazy Thinking

I’ve noticed a theme of lazy thinking, this week, in stories I’m telling and things I’m thinking about, and I’m wondering what that theme is leading me to. Am I doing some lazy thinking, myself? Is it just a coincidence?

For example, with the eye thing. I don’t want to go to the doctor about it, because I don’t want to go back to my old doctor. Changing jobs has given me a good reason to change doctors without it seeming personal. (BTW, I know that there’s nothing magical about the job-change, relative to the doctor thing— I suspect that my old doctor is approved by my new insurance, which is pretty identical to my old insurance, but the job change represents a bright line, and the bright line represents an opportunity to do things differently. I’ve wanted to change doctors for awhile, and it just took too much for me to overcome my inertia about it. If I go back to the old doctor, I may not make the change I’ve really wanted to make for several years.) I also don’t like to try out a new doctor in a situation like this— I’d rather go for a checkup than go in for something that I suspect is viral. Also, I don’t want to do the legwork to find a new doctor this week.

The reason I want to leave my old doctor is that I’ve observed a pattern of lazy thinking. Here’s an example: I go in. My tonsils are inflamed. The PA looks at them and says “you have tonsillitis. Take these antibiotics.” I say “you’re not going to run any tests? See if I have strep?” The PA says “No, because if you have strep, the antibiotics will knock it out. I’d treat you the same either way.”

Okay. So I take the antibiotics. But after I stop, the tonsillitis comes back. He tried to tell me I hadn’t finished my course of antibiotics, or that I took them wrong. When I proved that to be untrue, he said “You just needed longer/stronger meds” and sent me away with another prescription for antibiotics. Still no tests. A few days into the course of treatment, I don’t feel better. I understand that you have to take the whole course— my BFF is a pharmacist and I’ve been roundly schooled on antibiotic resistance and am a model antibiotics-taker (at the same time every day, with probiotics, etc.) But you should feel mostly better within a day or so. And my throat still hurts. So I go back the day after I finish and ask to see someone different. I demand that this PA run tests— take a throat culture, take some tests— my insurance covers diagnostics, and I’m not going to say yes to another course of antibiotics without them making any progress in understanding what’s going on with me. She gives me a “just in case” prescription for antibiotics, because when my tonsillitis returns, it returns with fevers in excess of 104 degrees, and the tests won’t be back until Monday morning.

I feel terrible over the weekend, but my fever doesn’t start to spike until Monday morning. I call her and leave a message that says “my fever’s 102. Do I fill the just-in-case prescription, or do you have data that tells us to handle it differently?” She calls back a few hours later. “Good news— you’re perfectly healthy. Not a thing wrong with you. Don’t fill that prescription.”

I say “I think I need more information about how I can be both perfectly healthy and running a fever in excess of 102.”

“Wait, you’re running a fever?”

“Yes, I left a message about it. You said that’s why you were calling.”

“Oh, I missed the part about the fever. Let me call you back, but yes, fill the prescription.”

I’m getting in my car when she calls back. “Don’t fill the prescription! We think you may have an abcess on your tonsils we can’t see. We’re sending over a prescription for Prednisone and a referral to an ENT, who can do surgery before it bursts. If it’s not an abcess, he’ll probably take your tonsils out, at this point.”

She couldn’t have known that it was one day before the anniversary of the day my mom had an (entirely unrelated) post-surgical secondary infection abcess burst before they could get her into surgery, which had her hospitalized or at a recovery center fighting infections for another four months, so I immediately start to melt down. I drive to the pharmacy, get the Prednisone and force the ENT to see me ASAP (the next day.)

The ENT looks at me for 30 seconds and says “you don’t have an abcess.”

I said “so you’re going to take out my tonsils, then?”

He looks again. “No, your tonsils are healthy.”

“But I’ve been told I had tonsillitis three or four times this year (once earlier in the year than all this) and done course after course of antibiotics to fight it.”

“Yeah, but your tonsils aren’t the problem, they’re a symptom. And they’re functioning as a warning system for your body, which is kind of what they’re there for. What you have is very likely viral, so I’m going to test you for these things, because they’re most likely.”

For those of you playing along at home, antibiotics are ineffective against viruses. This story went on for, like, two more months, but the ENT was the only person who wasn’t guessing about my diagnosis or treatment with no apparent application of their medical training. During that time, my doctor continued to behave in strange, hard to explain ways, suggesting things like having my tonsils and/or lymph nodes prophylactically removed. An ex called that behavior “swinging wildly.” I don’t really go to the doctor to experience it. The ENT never figured out the nature of what I was up against, either, but concludes it was a powerful virus that the Prednisone knocked out, and that it did some damage on the way out that I coped with for a couple of months thereafter. He laid out a narrative based on my symptoms that makes some kind of logical sense.

Since then, they have misdiagnosed me with bacterial tonsillitis another time. I went to the ENT after I could tell the antibiotics weren’t working, and he said “yeah— you have a virus again.” I told him I wanted to switch doctors. He let me know that I probably wouldn’t find anything different at another doctor. His wife is a virologist and they talk all the time about how overprescribed antibiotics are, but it’s just standard practice.

But I think it’s just lazy thinking. Every time I go in, I say “listen, I’m not here for a prescription, I’m here for a diagnosis. If what’s wrong with me can’t be treated by antibiotics, tell me so and I’ll believe you and follow your instructions.” The last time they misdiagnosed me I told them “listen— the last several times you diagnosed me with tonsillitis, it turned out to be viral, against which antibiotics are entirely ineffective. Can you take a moment and be sure it’s bacterial?” The answer was no. It was too much to ask.

I didn’t want to go to them because I haven’t yet picked another doctor, because I had the strong suspicion that I didn’t have bacterial pinkeye, whatever I had. And I was pretty sure they’d treat me with antibiotic drops, which, it should be obvious by this point, would enrage me. It’s okay to have default positions and to apply Occam’s razor, but when someone asks you to run some tests or to explore other reasonable possibilities because of a history, I think it’s only reasonable to at least consider it. I don’t think I’m a doctor, but I generally go in with some information about what could be going on, so an informed conversation seems like a reasonable request. As I told my mom, “yes, it could be bacterial pinkeye or [list of alarming possibilities raised by my Facebook friends], but it could also be alien abduction, and all of these possibilities are equally unsupported by evidence.”

Between that and the “objective truth has no meaning in this conversation” from yesterday, among other things, I find myself with a growing impatience with lazy thinking. And sometimes that impatience signals that I’m bothered by something I’m doing, and starting to see it other places. But at this point, it’s not yet standing out for me. So keep a good thought and I’ll keep sleuthing!

Or maybe I’ll do some kind of series on argument. How to build a good one, logical fallacies, all the invaluable things I learned in rhetoric and geometry and AP American History. Nothing like a good self-righteous series of diatribes to celebrate springtime!

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4 thoughts on “Lazy Thinking

  1. I can see why you would be frustrated and wanting a new doctor. As I’m sitting here watching Grey’s Anatomy, it occurs to me how often doctors don’t know what’s going on and how throwing a prescription at it seems to be the easy fix.

    • It’s true. Although what I found out was that I didn’t have pinkeye— I had keratitis conjunctivitis— basically an infection of the cornea. And I am on antibiotic/corticosteroidal drops, even though the eye doctor admits that it could be viral— he says it’s too dangerous to my long-term vision not to treat, and, as a matter of policy, he doesn’t send samples out to be cultured, so there’s no way to know if it’s viral. I have my follow up today and hopefully, my delay won’t result in long-term damage I can’t live with.

  2. Pingback: Roller Skates | Adventures of Auntie M

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