Looking good for your doctor’s appointment

~ Carolyn Thomas

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by Carolyn Thomas  ♥  @HeartSisters

I remember that moment very clearly. I was sitting in my kitchen, staring at the wall clock. Like many newly-diagnosed heart attack survivors, I was in the throes of what we now know was completely unexpected post-hospital discharge depression. I had a follow-up appointment with my doctor that morning, and at that moment, I was having a very hard time trying to decide whether or not I should wash my hair.

Normally, shower/hair-washing is just part of my regular daily routine – not something to be decided at all. But on this day, some part of me knew that this might be the third or even the fifth day in a row I’d gone without bothering to shower, and maybe I shouldn’t let my doctor see me like this. 

Wouldn’t want her to see how bad things had become for me. Wouldn’t want her to see me without my perfect pasted-on happy smile/make-up/clothes/hair.

Leslea Steffel-Dennis is a heart disease survivor who co-facilitates the WomenHeart support group in Vancouver, Washington – one of over 100 such groups in the U.S. and Canada.  Like me, she is a graduate of the annual WomenHeart Science & Leadership patient advocacy training at Mayo Clinic. Leslea wrote to me recently about this very common dilemma:

Should we let our doctors see reality, or our smiley-face pretense that we are ‘Fine, just fine’ – even when we’re not fine at all?”

Leslea started with the brilliant Elizabeth Banks film called “Just A Little Heart Attack” (you can also watch this 3-minute film by scrolling down this page and clicking on the right sidebar link) in which Elizabeth’s character keeps gamely smiling and insisting to her family that she is “fine, just fine” – despite clearly evident heart attack symptoms.  Leslea wrote:

“What it did for me was bring up the concept of the next chapter/film – looking good for my cardiology appointment.

“Like having nails nicely polished hot red, so the Doc can’t see any symptom that would show up in my fingernails.

“Or a thick slather of foundation to hide the sick color my skin really is – and don’t forget to put some on the bruise marks from the anti-platelet meds.

“And when the Doc asks how you feel, it’s not the time to say ‘Well, I felt a whole lot worse when I made the appointment, but pretty good now.’

“Or how about ‘I was keeping a journal of my symptoms but I forgot them at home’?”

In other words, let’s not make a fuss. It’s not that bad. Don’t whine. Don’t complain. Don’t draw attention to yourself. Smile sweetly and try to act normal.

Leslea’s list brings up the maddeningly typical tendency of women to try to minimize or dismiss their cardiac symptoms in general. Behavioural psychologists call this normalcy bias.

I’ve met women, for example, who showed up in the E.R. in mid-heart attack while apologizing for making a fuss, or self-diagnosing aloud their unusual cardiac symptoms as “it’s probably nothing” or “most likely just pulled a muscle from gardening” – or, as Elizabeth Banks says on the phone to the 911 dispatcher in her film: “Sorry to bother you…”

WOMEN!  Stop doing this!

As I described in an earlier article about something doctors call “treatment-seeking delay behaviour“, a study out of Oregon Health & Science University published in The American Journal of Critical Care showed some truly disturbing results – mostly around women’s denial of symptoms and reluctance to seek emergency help – yes, even while experiencing severe heart attack symptoms.

Researchers identified six common patterns of behaviour between the onset of women’s first cardiac symptoms and their decision to seek medical help.  These six patterns are called:

  • knowing and going (women acknowledged something was wrong, made a decision to seek care, and acted on their decision within a relatively short time, typically 5-15 minutes).   . NOTE: This is the only smart response.
  • knowing and letting someone else take over (women told someone they had symptoms and were willing to go along with recommendations to seek immediate medical care)
  • knowing and going on the patient’s own terms (women wanted to remain in control, were not willing to let others make decisions for them, and openly acknowledged that they did not like to ask others for help – these are the women who drive themselves to Emergency!)
  • knowing and waiting (women decided that they needed help but delayed seeking treatment because they did not want to disturb others)
  • managing an alternative hypothesis (women decided symptoms were due to indigestion or other non-cardiac causes, and were reluctant to call 911 “in case there’s nothing wrong and I’d feel like a fool”  – until their severe symptoms changed or became unbearable)
  • minimizing (women tried to ignore their symptoms or hoped the symptoms would go away, and did not recognize that their symptoms were heart-related)

Do any of these sound familiar to you?!

But even women in that first ‘knowing and going’ behaviour group admitted being confused about the symptoms of a heart attack. The biggest obstacle to reducing women’s treatment-seeking delays, according to the Journal of  Social Science & Medicine, is in fact women’s lack of awareness in interpreting heart attack symptoms.

Speaking of heart disease awareness, Leslea says that her focus now is on reaching young (50 and under) women:

“I want to warn them of cardiac risks and possibilities, to help them become aware, and to avoid the Big One later on.”

Maybe we can enhance this awareness by not trying so hard to hide how we’re feeling – especially when we’re with the very people who are supposed to do an accurate assessment of our health: our own doctors.

As Alisha Bridges wrote in her HealthCentral column:

“How many times has the doctor asked ‘How are you?’ and you give the expected response of ‘I’m fine.’  But deep down inside, you are stressed, overwhelmed and concerned about your condition. Stop doing this. Be honest and upfront with your doctor! Be transparent. 

“If you are feeling depressed about your situation, BE HONEST. There’s no doctor who can help you if he or she doesn’t know what you are dealing with.”

Maybe we could skip the nail polish, the foundation, the stoic determination to look good on the outside in order to mask the reality inside.

Maybe the doctor’s notes in our charts will start reflecting the truth instead of the fiction we help to maintain by pretending to be “Fine, just fine”.

.

Q:  Do you dress up or dress down for your medical appointments?

♥ NOTE FROM CAROLYN:    My book, A Woman’s Guide to Living with Heart Disease is published by Johns Hopkins University Press. You can ask for this book at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

See also:

The heart patient’s chronic lament: “Excuse me. I’m sorry. I don’t mean to be a bother…”

Women under age 55 fare worse after heart attack than men

“You look great!” – and other things you should never say to heart patients!”

The new country called Heart Disease

“I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack

Women heart attack survivors know their place

 

Published by Carolyn Thomas

24 thoughts on “Looking good for your doctor’s appointment”

  1. Hi this is my first time posting. I hope I’m posting in the right spot for the right topic, if not I apologize.

    I have to admit I’m very guilty of not seeking help when having chest pain for a number of reasons and yes I’m bad about always being able to blame them on, I honestly hate to say anything to bother anyone, I hate that every time something comes up everyone is having to do something to help, and of course yes there’s always that fear of what if it’s really nothing?

    Mainly with past physician experiences and being less than trusting because of those bad experiences, those are the main reasons why I try to wait and pray the chest pain passes.

    Is this smart on my part? NO I’m just not sure how to get past it.

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    1. Hello Elishia! I’m happy to address your questions here (or anywhere) on my site!

      It turns out that you are not alone in trying to avoid seeking medical help, yes – even for chest pain! As I mention in this post, researchers even have a name for this: “treatment-seeking delay behaviour”. You can read more about this phenomenon. All of the reasons that have kept you from seeking help are also listed in these studies. I too used almost every excuse I possibly could!

      Is treatment-seeking delay “a smart thing to do”? I suspect you already know the answer to that question! As to how to get past these excuses, I like to advise women to imagine what they’d do if these symptoms were happening to their friend, or daughter, or sister, or mother, or any other woman you care about. You’d probably be insisting that they MUST go and seek help, right? Turn that around and seek the same kind of help for you, too.

      Right now, you have no idea if your symptoms are heart-related or not. But something is causing your symptoms and you need to find out what. If I were you, I’d start keeping a symptom journal over a period of time (listing time of day, what you were doing at the time, what you had been eating or doing in the few hours leading up to first symptoms, etc.) Show this list to your physician for a thorough discussion of what might (or might not) be causing them for your own peace of mind. Best of luck to you…

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  3. This is a great post – thank you! I was a “managing an alternate hypothesis” until, 12 hours later, I was reasonably sure I needed to be “checked out,” after which I became “going on the patient’s own terms,” which included a shower (and yes, shaving!), makeup, earrings, hairstyle, drive self to ER.Thankfully, I’m not paying for those poor decisions in long-term damage.

    I was in an American Heart Association video (patient stories) last winter, in which they went with me to a cardiologist appointment. I was shocked when I watched the video to see how horrible I looked, how sad my voice is, how pale and flat my face looked, even though I’d used a heavy hand with makeup for the cameras.

    I’d been sick and miserable, and it showed.

    Thankfully, there aren’t cameras every time I see my doctor. But it is important that my doctor saw that. Yes, the stent and angio had “fixed” the current troublesome artery, but I was clearly not well. There’s way more to the story.

    Jen

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    1. Hi Jen – lovely to hear from you again. I suspect that our reluctance to look “horrible” is impacted by women’s cultural socialization to care about external appearance at all times – yes, even when we are desperately ill. Nobody likes to see photos/videos of themselves when not looking one’s best – and heart disease can make us look especially sick because we ARE sick. I agree – important for your doc to see all of that.

      * Heart Sisters readers: for more on Jen’s compelling story, read this

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      1. I just don’t want to smell for the regular appointments, but ER saw me a great deal this year, braless, sweatclothes and in those skidless socks from my last visit….maybe cleaned, maybe not…I don’t remember thinking much more than I hope they can find a vein!

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  4. My hair stylist and I have a running joke about how I always make sure to get a haircut right before my catheter ablation follow-up appointments. I’ll admit I don’t want to look too scruffy for the doctor.

    There is other aspect of “looking good” that I once took to heart. Just to stress the elusive concept of “normal activity,” I wore my full bicycle racing kit (outfit, not including weird cleated shoes) to an appointment with the local electrophysiologist.

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    1. Hi Genevieve – I’ve met heart attack survivors who told stories of shaving their legs while waiting for the ambulance to arrive after their hubbies had called 911 for them. Wouldn’t want the E.R. staff to see any stubbly legs. . . I have nothing against silky-smooth legs, mind you, but it does beg the question: “Aren’t you in the middle of having a frickety-frackin’ HEART ATTACK?!”

      Your own cycling attire would be duly noted by your electrophysiologist and confirm that you were indeed getting “normal activity” in a way that just mere words could not. Thanks for a great visual there! And think of the possibilities: ski-jumping suits? synchronized swimming gear complete with headpiece and gelled hair? fencing outfit? Endless possibilities! 😉

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  5. OMG, Carolyn, I am sitting here laughing.

    I had just sent my husband out to buy some touch-up hair color because heaven forbid my doctor sees me with a few gray roots showing.

    I, too, have done the “I must look good for my doctor” when I am barely able to do normal basic things. I do have a heart condition, but right now my major issue is back problems. Yeh, somehow other parts of the body seem to continue to go haywire, too. It’s like they don’t realize we are dealing with heart issues also:)

    I have finally decided the hair coloring can wait since my movement is limited …being clean and presentable is good enough.

    Thanks for your blogs, Carolyn. So many times they are so timely for me. So right on the money. You are informative and entertaining.

    Hugs from a WomenHeart SistA,
    Dotti

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    1. Dotti, that is hilarious! I wonder if any of our doctors actually realize the lengths we feel obliged to go to just to show up for a routine appointment?!?!

      Nice to hear from you – you’re in Michigan, right? XOXOXO
      C.

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    2. Guilty of bonding in the shower with a bottle of hair color! I’d like to say it’s because I’m meeting a well-respected surgical oncologist tomorrow (female, yeah). Actually, right now, i just feel the need to look pretty for myself with all the unknowns in my life. When asked how I am by almost everyone, including doctors, is “okay.”

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  7. Right after my heart attack, I didn’t care what I looked like when I saw my doc. I would sometimes come straight from cardiac rehab. I figured he had already seen more of me than either of us had ever wanted him to when I went in for emergency heart attack treatment. I figured he didn’t care what I looked like. I also figured if I looked a little frumpy, it meant I was feeling a little frumpy and he would see that by the way I looked.

    About six months after my heart attack, I did feel the need to “dress” for the doctor and not appear to be a sick person. I wanted to appear healthy and functioning – and physically I was. Emotionally I was a wreck and I was trying to stuff this in when I saw the doctor. I thought, “I must not cry. I must be able to talk in coherent sentences so he doesn’t see me as some whiny, blubbering female.”

    At my last appointment, my doc did say, “You look great.” I was okay with that since I’d gone down a couple of sizes in jeans! : )

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    1. Angela, you brought up a very important point when you describe feeling like an emotional wreck yet “trying to stuff this in” around your doctor. Very common reaction! But when we do this, aren’t we depriving our doctors of valuable information/education about what heart patients go through? We know for example that up to 65% of heart attack survivors suffer depression, yet fewer than 10% are appropriately diagnosed. No wonder! Maybe those stats might change if we weren’t so determined to “stuff this in” – or maybe doctors could become educated by their patients who tell the truth, i.e. that feeling like an emotional wreck is a normal human experience after surviving a cardiac event.

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      1. Carolyn,

        I made a decision about my cardiology appointments that I thought would benefit me more in the long run as a patient. I decided he was my doc who could tell me about my heart. That was his job and his focus. After all, I only have 15 minutes with him. I told myself if I needed counseling or emotional help, I needed to seek that out elsewhere (i.e. with my primary care doc). I suppose for him to be a more well-rounded doc, I could have clued him in more as to my emotional state at the time. I think he knew to some degree though, as there were times he would stop himself in mid-sentence. These were usually times I could feel myself fighting back tears. Maybe he didn’t know what to do with my reactions or didn’t have the time to respond to them.

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        1. I hear ya! A cardiologist at Mayo Clinic once told me that cardiologists are like “mechanics” – very good at fixing this one particular organ, but often not in touch with the fact that there’s a whole entire person attached to the organ. My own cardiologist (a wonderful doctor) once listened to me talking about my own alarming symptoms of severe depression and mused: “Well, it could be the beta blockers you’re taking. . . “ to which I replied: “NO! It’s because I just had a frickety-frackin’ HEART ATTACK!” Sigh….

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  8. I find myself in the same boat as Julia… “Wow! So there are other women as crazy as I am?”

    I’ve had 2 Heart Attacks. With the first we drove to the ER (It’s only 3 miles down the road…). When the 2nd hit, 911 got called. That time I knew exactly what was happening!

    I try to put my best costume on but find that sometimes it just doesn’t get fully put on. After 2 events, the damage is significant & I’m sometimes just too dang tired to care! Yet, with some of my doc’s, they get “I’m fine”. I do try very hard not to be too much “a woman” when I meet with my Cardio.

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  9. Great wake-up post: “Fine, just fine” can have serious health consequences. Like when I dressed up for my first appointment with a particular cardiologist and impressed him with my fitness, my fabulous condition – I sure did!

    But looking as bad as we feel may not serve us either. In Groopman’s book “How Doctors Think“ he outlines several cases in which doctors didn’t like the looks of someone (too dishevelled or whatever) and made an assumption that adversely affected the treatment.

    Now I try for: always clean and neatly dressed, careful notes in hand, but no mask. Let’s not be too hard on ourselves. It’s hard to hit that in the doctor’s office when every day the whole world just wants to hear “Fine, I’m just fine!”

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    1. Thanks so much for the reminder about Groopman’s excellent book, Kathleen. I think you’re right about the whole world’s expectation of us – and that includes our doctors, too. We get sick, they fix us up, we get better, they feel good! When we get sick and keep looking bad despite their best medical efforts, they don’t like it!

      I wrote more on this in How To Be A “Good” Patient.

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  10. Wow! So there are other women as crazy as I am?

    I thought I was in a category all by myself! I’m the type who drove herself to the emergency room and of course I got to wait in the emergency room waiting room because how serious could it be if she drove herself here? I was busy being pleasant and keeping my sense of humor etc. while my heart was dying.

    I have, thanks to this foolishness, 15% loss of heart muscle because I was busy not being a bother and being in control! Why do we do this crap?

    Now a-days I don’t worry about my personal looks as much as my health, still I put on my best costume when I see the doctor…….why ? He doesn’t give a hoot nor do the people who work there.

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