Even when I am not “working” as an NP, friends and family still solicit my advice. That’s no problem. I can’t stop thinking like a nurse practitioner, keeping up with new advances in health care or wanting to help people negotiate our health care system, which is broken, in so many ways.
What advice do I give? Sometimes it’s a matter of using the right lingo, even some key words, emphasizing one symptom, and being persistent. It also helps to put yourself in the shoes of your health care provider. NPs, MDs, PAs, we all want to solve your problem. We love a mystery, and most of us really care about making you feel better. So if you finally get an appointment and describe your problem — back pain, say — the assumption is that you want it to stop, at all costs. But is that really the case?
Maybe you can put up with the pain. It’s not that bad really and gets better as the day goes on. But you want to make sure the pain is not caused by anything serious, and rightly so. A malignancy is always in the back of one’s mind, as well as that of your provider. Or maybe it’s something that, if not treated, is sure to get much worse. You don’t want that either. Providers get 15 minutes a visit, if they are lucky, and they have a lot of mandatory charting to do on the computer. You have to distill your symptoms and your concerns and communicate them succinctly. That is just the way it is these days.
Perhaps the next step is some kind of imaging, an ultrasound, Xray or MRI. The radiologist who reads the image is likely overworked and usually errs on the side of caution. So further imaging might be suggested to rule out “something bad.” MRIs and ultrasounds are fairly benign in that they don’t expose you to radiation. CT scans do and the exposure is cumulative over a lifetime. What you decide to do is dictated at times by the level of uncertainly you are willing to live with.
Sadly, this can be a slippery slope. You then see an orthopedist who tells you your pain is caused by a benign cyst pressing against a nerve on your spinal cord. You could get it removed or injected with a steroid, which might alleviate pain or cause it to “pop.” The orthopedist gives you these options because you consulted her about your pain so obviously you want her to make it go away. Now you are on to invasive procedures and invasive procedures, every one, has the potential of making things much much worse.
Always ask what happens if you do nothing. Might it get better on its own? Might it just stay the same? Consider if you can live with this new normal. And of course, there is always a second opinion.
Case in point: I am a runner and developed arthritis in one foot that caused significant pain after, but not during, a run. I consulted an orthopedist who was touted as being a runner who specialized in foot problems to see if there was any recourse. Orthotics, joint replacement, I was open to hearing about options. I was concerned it would get worse and prevent me from running. First red flag was when he was surprised at how far I ran – 6-8 miles. He was a runner, after all, that distance should not have surprised him. Then he suggested a little surgery to “clean the area up.” There is not such thing as “a little surgery,” but I had already written him off by then. I sought out another orthopedist specializing in feet, who looked at the Xray, did a quick exam and said he would never operate on me because, although only a surgical fusion would relieve the pain, I would no longer be able to run afterwards. He suggested a steel orthotic available on Amazon. Six years later, I am still using it and still running.