Migraine Awareness Month Day 11-Say What? She did what?
Prompt: Say What?!” What’s the most ridiculous thing ever said to you about Migraines, who said it, and under what circumstances? Well… There are so many ways I could have gone on this. Told a light story, talked about people asking me if I had tried x, y or z. But, I’m not going to. I’m going to tell the true nightmare that happened due to lack of education on a doctor’s part. This is hard for me emotionally, and I hope I can post this not out of anger, but out of sheer sadness. I wrote this in 2007, in response to an incident that occurred in 2006. Names have been changed due to the outcome of this series of events, and the agreement between the Health Center and myself. A lengthier version of this post was discussed with the head of the Health Center >>>>>>>>>
As per HIPAA, I have the right to have my record corrected, or at least amended to reflect the correct information regarding the events of the 11/20 appointment with Dr. Migraineingnorant.
There are many factual errors in the medical record.
On the day in question, I arrived early for a follow up appointment with Dr. Migraineingnorant. While sitting in the waiting room, I began to develop a migraine with aura. The screams of the happily playing children, and the less happy children hurt my head. I took my prescribed Triptan (Frova). I always carry frova on me, as I don’t want to get to the point where I am incapacitated by the pain. I sat back and waited for it to kick in.
That appointment was only the third time that I had met with this doctor. I had been rear ended in a car accident on xx/xx/06, and upon release from the emergency room, I was told to follow up with both the Spine Center and the Family Medicine Clinic. Since I did not have a primary care provider already there, Dr. Migraineingnorant was randomly assigned to serve in that role. I had seen her previously before that day for a total of, at the maximum of 35 minutes.
RESPONSE AND ADDENDUM TO MEDICAL RECORDS:
- Patient presented with a migraine, which was communicated to the triage nurse several times. It is possible that said nurse did not understand the various components of migraine. It is a neurological DISEASE, not “just a headache.”
- My speech difficulty was attributed to the migraine aura. Auras are not just about flashing lights, but can also have additional components, including difficulty finding words, slurred speech, (and/or speech difficulties) vertigo, perceptual disturbances such as space or size distortion and confusion.
- Upon greeting me, Dr. Migraineignorant. asked how I was feeling. I said that I had a migraine. She told me that she was worried about what the nurse had told her regarding my behavior. Again, I repeated that I had a migraine, and these were classic symptoms of an aura- which was lingering with the intense throbbing pain. She told me that my behavior was concerning. I agreed that it would be disturbing if there was no explanation for said behavior. Either she was not listening, or she lacked the knowledge to understand why the behavior was not erratic.
- I would NEVER take a TCA to abort a migraine. A TCA is a tricyclic antidepressant. I took a TRIPTAN. In fact, I told her what I had taken- Frova. She hadn’t heard of it. I tried again- “frovatriptan?” Still, that blank stare. “It’s a cousin of Imitrex.” That should have been a clue that this was not a TCA, but a migraine abortive, prescribed to me by another clinic at that hospital complex.
- I was to get the results of the MRI taken earlier that month at the spine clinic the next day. When Dr. Migraineignorant mentioned that she’d give me the results that day, I knew that either if positive or negative, I was in for additional pain. Hoped that it would show something that would be easily fixable. When I was informed that the MRI had come back negative, I did start to cry. No easy fix- more pain to come, more of the same was in my future. However, I did not become hysterical. In addition to this fact, migraine itself may lead to increased eye tearing and additional nasal drainage, causing the physical appearance of the patient to not accurately paint a complete picture of the patient at the time of observation.
- Dr. Migraineignorant said that she feared that left to my own devices, I was going to hurt myself. I laughed. I explained that there have been times in my life when the antidepressants weren’t working correctly- and I hadn’t done anything then…If I hadn’t hurt myself when acutely depressed, there would be no reason to believe that I would do anything harmful to myself at this point. In addition to this fact, another reason for crying could be attributed to coming down from the active part of the migraine- a stage called “postdrome,” which, for some people has the added effect of causing lowered mood levels, causing a transient depressive state. In addition to this, I added that I have regular contact with my psychiatrist, and she was aware of how I was doing, and did not feel that there was any reason for concern.
- My psychiatrist was called with Dr. Migraineignorant in the room. If she was concerned about psychosis, this would have been an appropriate way of addressing the issue without sending the patient to the ER.
- Dr. Migraineignorant left the room, saying that she was going to go find her supervisor. She returned with another doctor, whom I naturally assumed was the supervisor. and we had a good conversation. No crying or abnormal behavior.We discussed my car accident, my job, and insurance. I figured that the whole episode would be over, as it had de-escalated from an antagonizing patient-doctor relationship to a pleasant one. I was wrong. Migraineignorant had actually sat someone in there to keep an eye on me so that I did not just walk out, as there was nothing more that needed to be said at that point.
- She returned with two uniformed officers. They were to escort me to the ER either “voluntarily,” or by other measures. These were University police, not the Orange County Police Department.
- Patient was not “asked” to be evaluated. Patient was threatened with 48hr psych hold if she did not go up to the emergency room to be evaluated.
- Patient was later released from the ER and drove herself home.
She was convinced that I was either on drugs, or psychotic, and there was nothing that I could have done or said, short of bringing in a doctor from the headache clinic to attest to my story.
Family medicine is patient-centric, and pigeonholing based on atypical behavior is a dangerous practice for a physician to learn. Many serious diseases (including migraines) have symptoms that may resemble other illnesses, and if the patient has been diagnosed with one of these conditions, it is the responsibility of the doctor to at least learn a little bit about what makes this “abnormal behavior” not a psychiatric problem per se. It is not the patient’s job to educate their health care provider.
What would you have done in this situation?