Family Stress in the Exam Room, Part One

I think of the exam room as a sacred place.  I often refer to it as my temple.  I want patients to feel that the conversation we’re having is not only confidential, but also an important step on the path to healing.  Many people tell me that they feel better the minute they walk into my office.  I think that they say that because they know they will be able to “unload” unnecessary baggage during their visit.

Although the gist of the conversation is supposed to deal with medical issues such as aches and pains, sometimes we end up discussing personal issues that may have a bearing on the patient’s symptoms.  I’ve seen many arthritis flares that were provoked by excessive activity.  Some people feel so much better with treatment that they tend to overdo it.  I recall the day that an avid golfer came in complaining of increased stiffness and new swollen joints.  His medication was unchanged; I could not figure out why he had “flared.”  Until he told me that he had played 72 holes in one day because he felt so good, and it had been so long since he had been able to play pain-free.

There are times when the disease has improved, but I get the feeling that patients are lingering in the room, as if they have something else they want to say.  A few weeks ago a middle-aged woman asked if she could bring her husband into the room.  She had been in much pain and she was beginning to turn the corner.  We had discussed her medicine and her test results; I felt that we were done when she spoke up.

I asked her to bring him in.  After he sat down I noticed an air of tension; something that was not present when he was not around.  She asked me to explain to him what kind of medicine she was on, and to instruct him on some of the possible side effects.  Half way into my discussion she said:

“So it’s not all in my head, right?”

At that moment I realized that I was being used as a prop in a marital struggle; a conflict that had nothing to do with her arthritis but would definitely have a hand in determining her outcome.

This is not an unusual occurrence.  When people get sick the fabric of their lives is torn inside out.  New routines need to be established.  Many times the stress of disease threatens the stability of a relationship.  I recall a quote from a famous French actress who said something to the effect that people are not bound together by chains; that couples are more or less hanging by a thread.  If we don’t nurture the partnership at times of illness things may come unraveled. 

Why should a sick person have to feel that they must convince a loved one that their illness is real?  Why would a loving partner even question the other person’s pain?

These are sensitive and important issues.  Next week I’ll share some of my thoughts on this matter.

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