If you have chronic pain or illness, chances are you’ve been there more than once. You go to a new doctor, full of hope that this time you’ll get the care you need. But instead, you’re told that your problem is all in your head.

The doctor may seem like she’s concerned about you… at first. Then, when you’re starting to relax, she throws a curveball at you. She might use some fancy medical term that turns out to be something that basically means your problem is either psychological or a useless “trash can” diagnosis that turns out to be too vague to help you (and could be a just plain wrong).

I’ve read a lot of posts and articles that offer advice about what to do to protect yourself against condescending or gaslighting doctors.

The advice tends to go like this:

1. Bring a friend or family member with you
2. Be prepared with specific questions so that the doctor doesn’t end up going off track
3. Educate yourself as much as possible about your condition

Not only is this advice obvious, it’s simplistic. Most of us know how to do these things. And some of it’s bad advice. Yes, educating yourself is smart. But it can get you in trouble if you talk about what you’ve learned. Doctors often react badly if they think you’ve been Googling too much.

And while it’s important to bring some kind of ally, that doesn’t mean they’re going to be able to help you. They might end up feeling just as powerless as you do.

The fallout from these encounters can last a long time. We go to doctors for help, sometimes traveling long distances to see them. Then they tell us that it’s up to us to get better, that we’re creating our own symptoms, or some other nonsense.

It’s emotionally exhausting, and it means we’re no closer to getting our needs met. It’s no wonder so many people give up trying.

Doctors often react badly if they think you’ve been Googling too much. 

To stay in the game, you need ninja level skills. You have to know what to say and how to behave. Otherwise, you’ll burn out. You’ll start avoiding doctors, or settle for less than you need and deserve.

Why do doctors do these things?

They’re doctors. They’re supposed to be scientific. Yet all too often, they lean on explanations that are weak at best and total BS at worst.

First, some background.

Most doctors went into medicine for the right reasons. They wanted to help people.

In medical school, they learned a lot. But then they went out into the real world, and patients started showing up with stuff that they couldn’t explain. Their symptoms were all over the place. They didn’t fit the neat boxes they’d been taught.

It’s no wonder so many people give up trying.

Faced with this kind of chaos, most doctors react with feelings of confusion and powerlessness. They then try to defend themselves against these feelings.

This can take many forms. But too often, they feel they must diagnose a patient with something. Because the alternative is saying “I don’t know.” And this, for many doctors, is the most difficult thing they can do—especially when faced with a patient who’s clearly in distress and desperate for help and answers.

What we actually want is for them to be honest, and to hang in there while searching for answers that will help us. But their training tells them otherwise.

Doctors are also all too human. They have prejudices. They have taken in the same beliefs as the rest of us have about women, people of color, and other races and ethnicities.

Even if your doctor is a woman, she can be just as sexist as any man. She’ll label women hypochondriacal more often than men. Black women often get it the worst—they’re labeled overdramatic, and their symptoms are dismissed, no matter how serious they may be.

Men also get a bad rap. They may be viewed as drug seekers more often than women. They might be told to “man up” and white knuckle their pain. And they also can be told their problem is all in their heads.

Trans folks have it perhaps worst of all. Many doctors are uncomfortable with the whole idea of transgender people. Most are ignorant about the basics. This means many trans folks are denied even the most basic medical care.

Saying “I don’t know,” for many doctors, is the most difficult thing to do.

Another reason doctors can be so difficult to deal with is that they’re always thinking, rather than listening and observing. We all know the experience of sitting in a doctor’s office and spending most of the time looking at their back because they’re on the computer the whole time. Even if they seem to be looking, you can see the wheels turning inside their heads.

That’s because the kind of people who go into medicine are those who are good at taking tests, memorizing facts, and generally being the smartest kid in the class. Even after years of practice, most doctors are book smart but lousy at dealing with people.

They’ll cover up this problem in all kinds of ways. Sometimes they’ll throw a bunch of medical jargon at you. Other times, they’ll act like they know more than they do because they’re still trying to prove how smart they are.

You never know how they’re going to behave, but you can be assured that most of them are insecure about their intellectual abilities. They may also have no idea just how bad they are at the human side of the job. Or if they do, they’re insecure about that too.

Even after years of practice, most doctors are book smart but lousy at dealing with people.

The biggest problem with doctors is that they’ve been taught that they should know everything about how the human body works. Anything that’s outside of what they do know can’t exist. Therefore, it has to be something psychological.

This explains why it took so long for chronic illnesses like Lyme disease, ME/CFS, and endometriosis to get their due. Medical science hadn’t discovered them yet, so anyone who had these illnesses had to be a head case. (And of course many doctors still haven’t caught up.)

But there are other issues with this as well. If you go to a specialist who doesn’t have experience in your particular type of illness, you can end up being told it’s depression, anxiety, somatization, or what have you.

This is why it can take so long to be diagnosed, especially if you have a rare disease. The same goes if you have less than common symptoms for a particular illness.

So, given all of these biases, prejudices and problems, how do you deal with doctors?

Well, the more you grasp all this, the better you’ll do when you meet with them. Remember that they’re human, flawed and though they mean well they don’t understand how limited they are.

However, even those of us who are aware of all of this can fall into what’s known as “white coat syndrome.” The minute we see that white coat, something in our brain freezes. We can’t help but see the person in front of us as an authority figure. (Health has a great article on this.)

So here is a five step plan for dealing with all of this:

1. Firat, you’re going to banish “white coat syndrome.” Before going to your doctor – especially a new doctor – use the technique known as the “circle of excellence.“ Choose a place on the floor and put a piece of paper down on it. Now, think of the qualities you want to bring with you to the appointment.
   1. This could be strength (“No one can push me around!”), confidence (“I know what I know!”), flexibility (“No matter what they throw at me, I bounce back!”) and anything else that might help. Sometimes it’s easier to think of people you admire. Try celebrities (Oprah, perhaps), teachers, and anyone else who you’d like to embody.
   2. Now, step onto the piece of paper and let the quality or person fill you up. Then just as the feeling is peaking, step off, Then move onto the next quality or person. Repeat the procedure. Once you’ve done all of them, step back onto the piece of paper and let yourself marinate in all you’ve loaded onto it. Step off. Then step back on to make sure you’ve locked everything in. If not, repeat the process until you have.
   3. For those who can’t walk, you can choose a floor area to wheel onto instead. If you can’t do that, then alter as needed—perhaps putting the paper on your bed and placing your hand on it each time.
2. Write a history of everything that’s happened since you were injured or became ill. Keep it reasonably short, but include everything you think could be relevant. If you’re not sure, include it. List your symptoms as well. Print it out and give it to your doctor. By doing this you’ve saved them time going over your history, which they often appreciate. It also puts the ball in your court, because they’ll be referring to your description of events and symptoms.
3. Before the appointment, jot down the questions you hope to ask. Make sure they’re all related to the doctor’s specialization. Keep these with you rather than handing them over.
4. At the start of the appointment, ask the doctor how much time they have. This way, you won’t end up in that all too common situation where just when you’re getting into something important, they cut you off and end the appointment. If they answer, “as much time as we need,” politely but firmly ask again, by saying something like, “that’s great, but typically how long does an appointment like this last?”
5. Don’t ask your questions or even say much until they’ve asked you every single one of their questions first. You need to learn as much as you can about them, their level of expertise, and any other intel you can gather before you make your move. Otherwise you could step on a land mine—for example asking about something they don’t understand. Remember, doctors hate saying “I don’t know.” Also, if you ask a question that shows you know more than they do, you’re at risk.
6. Don’t agree to an examination until they’ve told you exactly what it will entail and why they’re doing each action. This may not go over well. So remind yourself it’s your right as a patient. It’s crucial that you keep the power in balance, and that’s not going to happen if they’re manhandling you without explanation. And if you have pain, they might hurt you. If they refuse to do this, or try to get around it somehow, politely tell them this isn’t working for you and you’re going to end the appointment. Then simply stand up and walk out.
7. Assuming you reach the point where you’re ready to ask your questions, first ask the following, “given what we’ve discussed so far, what are you thinking?” The doctor might hesitate to answer, change the subject, or say something vague or noncommittal. If so, repeat the question, or rephrase as “Do you have a theory about what’s going on with me? It’s okay if you don’t.” This might be enough for them to admit they don’t know. If so, ask if they have suggestions for other specialists. If they do have an answer, you have some options. If you don’t know what it is, continue by asking clarifying questions. Also, you can look it up on their phone (or have your ally do so). That way, if it sounds like anything psychological, you can politely bring the appointment to a close. And if it’s something you already know is psychologizing, then of course it’s time to leave.
8. Your final step, assuming you’re still there, is to ask your questions. You can just read from your notes—skipping any that the doctor already addressed. Remember to keep an eye on the time. That way, you’ll be in control. When you’re at ten minutes before the end, ask, “what are my options going forward?” This way, you have time to discuss upcoming tests, appointments with other specialists, or maybe a treatment plan.
9. If they’ve given you their best, show your appreciation. Thank them for their time and effort. If they haven’t been much help, don’t fake gratitude. Tell them you don’t think this is going to work out, and then leave. The reason to do these things is that you want to end the appointment on the right note. Insincerity makes you feel bad. You want your head held high so you don’t end up with bad feelings.

A good doctor will be fine with your questions and requests. They might be a bit surprised because so few patients are this savvy. But they’ll work with you, and hopefully they’ll have something to offer you that will help—even if it’s just a referral.

Can I  really get up and leave in the middle of an appointment?

Yes! You’re the customer. You wouldn’t stay in a store if the salesperson was rude to you. 

i know, I know. We want to believe in doctors. And most of them do mean well. But that doesn’t mean they can’t harm you.

It can be difficult to have the strength to get up and leave. But remind yourself that you could be flattened emotionally for a long time if you don’t. Remember all the times before when a doctor made you question your own sanity. And if you have pain, don’t forget doctors can hurt you—and they’re often clueless about how to be sensitive to your needs.

So, there you have it. Follow this plan and you’ll never end up powerless or traumatized by doctors again. Not only that, but you’ll have the wherewithal to keep looking until you find one who can help you.

Image credit: National Cancer Institute on @unsplash