By: Dr. Pamela Tronetti, Sponsored by: Parrish Healthcare
I stepped out of the exam room so that my patient could get undressed. When I returned, she was still fully clothed and clutching the gown to her chest like a security blanket
“I didn’t tell you that I wear one of those… you know…” She looked at the floor. “…those pads for bladder leaks… just in case.”
‘I’ll tell you a secret,” I said. “Ninety percent of the ladies who come in here wear a pad or special underwear…just in case.”
“They do?” The look on her face was a mixture of shock and relief.
Many people become tongue-tied when it comes to discussing personal or potentially embarrassing topics. What are some of those forbidden subjects?
I’ve cared for everyone from cloistered nuns to exotic dancers. I’ve peeked into the waiting room to see a circus performer sitting next to a physics professor and a retired CIA operative helping a kindergarten teacher get a cup of tea.
Knowing a patient’s profession and hobbies helps us understand who they are, how they process information and their risks of certain illnesses. We really need to know if you are (or were) exposed to chemicals, animals or dangerous situations. It’s all part the tapestry that makes up your life, and it affects your health. If you are reluctant to have your profession documented in a medical chart, we understand. I’m sure many doctors have listed a patient as “self –employed” or “various jobs” when they knew it was best to be discreet.
I can’t tell you how many patients made an appointment for “a cold” or “just a check- up” when they really had questions about their sex lives. Often the inquiry involved basic information that was withheld during their formative years because of cultural or religious customs.
The most frequent concerns revolve around whether what the person is thinking or feeling or doing is “normal”. The answer is usually a resounding “Yes!”
Most doctors can answer questions about sex. If you are not comfortable asking your primary care physician, consider talking to a gynecologist or urologist. They are definitely at ease with the subject and have probably helped other people with similar problems.
Chronic bowel problems are also upsetting to patients. TV ads for probioitcs and laxatives have helped people feel more at ease when discussing constipation and diarrhea, but more severe symptoms are often left unspoken.
Some people are reluctant to admit that their constipation is so bad that they have to use suppositories, enemas or “digitally remove” the stool almost daily.
Fecal incontinence, the loss of control of the bowels, is more common than people realize. They may also not know that there are a lot of treatment options as well as specialized pads for folks with stool leakage.
Probably the most unnecessarily embarrassed patients have been those ladies who ultimately were found to have fistulas. A fistula is a hole between two organs as a result of infection, injury or inflammation.
One lady told me in hushed tones that she was “passing gas” when urinating, and that her urine was “as bubbly as champagne.” The cause was a fistula between the bowel and the bladder. The same can happen between the vagina and the bladder or bowel, resulting in abnormal passage of urine and/or stool.
Older patients are often hesitant to tell us that an adult child has an alcohol or substance abuse problem, is incarcerated, homeless or has made other choices that are now causing them serious heartache or stress. No one should have to live in chaos. We need to know if a relative is draining your bank account, your pill bottles or your mental health.
Doctors can’t fix something if we don’t know that it’s broken. Don’t be afraid to let us know what is really bothering you.Tags: Senior Issues