Robyn Pollman

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A Letter To Friends In Med School

Hi to you both!! I realize that both of you are busy w/ med school right now, so I'll try and make this as brief as possible. I'm just hoping that perhaps before "the system" drills their rules into you too much, that I can help you see things from the other side. It's my one and only shot to try and make a difference, so please bear with me. I really think that one semester of education in medical school should be provided entirely by the patients...

I guess you both know that I have Chronic Fatigue Immune Dysfunction Syndrome, Fibromyalgia Syndrome, Neurally Mediated Hypotension (diagnosed after a Tilt Table Test using Johns Hopkins protocols), Irritible Bowel Syndrome, and migraine headaches. Because my illnesses are so varied and have so many symptoms, there's an immediate attempt by the medical community to try and label or pigeon-hole me as "depressed". Maybe it's because it's just easier that way -- but it also seems to be what you are taught to do.

I am not depressed. My aunt and sister have clinical depression. I know the symptoms and I do not have them. And as such, I do not wish or need to be overly medicated in order to treat something I do not suffer from. My regular illnesses require quite enough medication on their own. The symptoms I suffer are no where near depression -- but just try telling certain doctors that. Todd and I have tried until we are blue in the face, and still get nowhere half of the time. I've even went to therapy in order to shut some of these doctors up. I'm always sent back to my doctor by the therapist, with a note that "I'm ok." (Todd even printed up a certificate for me that reads "NOT INSANE", a la Homer Simpson.) If some doctors can't label it as the "easy route" <gasp!> (i.e. depression) then they usually just give up, and refer the patient on to someone else. Otherwise, that would mean admitting to the patient that they don't know something.

In case you ever run across a CFIDS/FMS patient during your practices, please think back to this e-mail and the following:

"Chronic Fatigue Syndrome is a ~Real~ Disease" by Charles W. Lapp, MD, from the ~North Carolina Family Physician~, Winter 1992; Table 2, "Depression vs. CFS".

True Depression (Endogenous):

  • Lonely, hopeless, helpless
  • No apparent reason for depression
  • Anhedonistic: nothing is enjoyable, no interest in future
  • No future, all is useless
  • Wants to die

CFS Blues (Reactive):

  • Discouraged not hopeless
  • Who wouldn't be depressed? Can't keep up house, can't work, can't keep up with school work; but this *differs* from true depression
  • Wants to enjoy, wants to get better, no negative attitude
  • Makes plans for the future, looks forward to getting better
  • Terrified of dying

This is part of an article written by Barbara Pino, MA, MFCC, titled Chronic Fatigue Syndrome: Does It Exist? [Copyright (c) 1994-1997 by Pioneer Development Resources, Inc]

There are those who wonder what the difference is between Chronic Fatigue Syndrome and depression. Pain, weakness, fatigue, confusion, troubles concentrating, memory disturbance, and sleep disorders all can be symptoms of depression. They are different in the following ways:

Sore throat, swollen lymph nodes, and continual low-grade fevers are not symptoms of depression.

Depressed patients usually feel better after exercise, Chronic Fatigue Syndrome patients feel worse and this lasts more than 24 hours.

The biggest difference is anhedonia. If one is depressed they do not feel like doing anything, they lose interest. If a patient suffers from CFS they look forward to doing things whenever they will feel better, and they wish that they had the strengh and energy to do them at that moment.

Most people, whether healthy or depressed, can improve their performance on a memorization test by using reminders. Reminders are largely worthless to Chronic Fatigue Syndrome patients because of a problem forming new memories.

A depressed person can handle a brief interruption when memorizing something. Chronic Fatigue Syndrome patients' performance suffers six times as much from the interruption.

When asked to predict how they will do on a thinking test, depressed people tend to underestimate their abilities, while Chronic Fatigue Syndrome patients tend to overestimate theirs.

Next, before I get off my soapbox, I'd like to ask you to reconsider the way you are "taught." Apparently from the vast amounts of medical literature I've come across (I'm more read up on my illness than my own current MD, by her own admission), medical school students are instructed that if a patient is a "complainer", then they must have a psychological problem rather than a medical one. This is just simply not the case. Syndromes encompass a variety of symptoms -- not just one or two. If only it could be that easy...

From Dr. Peter Rowe, Pediatrician and Associate Professor of Pediatrics at Johns Hopkins University:
"In medical school, students are told if patients come in with more than four or five complaints, they should assume that those people have psychiatric or psychosomatic disease. That notion has to be exploded because of the fact that NMH and CFIDS have a tremendous number of symptoms, but they are all connected."

I am currently fighting my own battles along these lines. Todd and I had to obtain the services of an attorney to get my medical records amended. Not only did a neurologist of mine in Oklahoma claim that my illness appeared to be "psychosomatic illness," regardless of over 8 years of medical records to the contrary, both he and my MD also falsely recorded that I abused narcotic substances and alcohol. One copied the wrong report from a nurse, and the other copied the other Dr.'s report word for word...and so on...and it then became a matter of my medical record...without either ever even asking me if I used/abused drugs or alcohol. They both REFUSED to amend their mistakes in my medical records until we hired an attorney.

I have just been denied Social Security Disability on my first attempt, and it is most likely largely due to the errors of these doctors in my medical records, and their refusal to accept that they are men and not God. They were just that pompous until the law was involved.

While their retractions won't give Todd and me the $375/mo in disability that we both desperately need to make ends meet, it at least gives me back my "reputation." I've never so much as taken one hit off one joint in my entire life, much less abused controlled substances. I was given a prescription for Darvocet last fall due to excruciating joint pain (which was in my records) so both doctors just presumed it was a given that I abused drugs. Case closed. After all...I had complained of multiple symptoms... Never mind actually coming out and ASKING me, to get an accurate medical history.

One of my retraction letters states:
"...nursing records obtained from an R.N. that was taking care of this patient had revealed that the patient had a history of alcohol and drug abuse, so this was taken from those records. I had also noticed that Dr. Nameless had mentioned this in his report. Because of this, I then listed this in mine. At the time, because of the patient's history of intractable headaches, vague symptomology and history of use of Davocet and other medications, I was concerned that the patient may have shown some drug related symptoms. Also because of some psychosomatic symptoms, this was placed in the chart. However, later as the patient followed up, I felt that the patient did not exhibit any signs of alcohol abuse or drug abuse and appeared to be a stable patient with some chronic symptoms..."

But did this doctor (and I use the term loosely) ever bother to state this in his medical records until legal action was threatened? Did he think a follow-up to his prior statements was needed, once he realized that I did not use drugs? No. It took the threat of lawsuit for him to admit he had made a mistake. It was just too easy to label me as a psycho and a druggie/alcoholic and then forget about it.

My former MD also retracted his claims of my alcohol and drug abuse by stating:
"I have been treating Ms. Pollman since September of 1996 - 1999. During subsequent visits to my office I have found Ms. Pollman to be a very compliant and credible patient. I would like to state on her behalf that she does not abuse any substances such as alcohol or narcotics."

Again, this doctor refused to amend my medical records until the threat of legal action was placed over his head. In fact, he told me over the phone that they could not legally be amended. It took an attorney to prove otherwise to him.

I'm not trying to "attack" you. There are great doctors out there, and I've had some of them, thank goodness. I'm just trying to get you, no begging you, to think about the patient as you begin practicing medicine. That's why you are there. That's who pays your salary and who pays off your student loans. We patients are human, and we can be hurt by you and your medical position/power. We can also be abused by it.

If there are any questions that either of you ever have regarding any of my illnesses, please feel free to contact me. If I can't answer it, I will find someone who can. I can't write every med student in the country -- but two is a start. Ha ha!! Aren't you the lucky ones??

Robyn Pollman

© Robyn Pollman, 1997

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