Maybe you’ve had a horrible week, but by the time your therapy session rolls around, you feel fine. Or maybe you’ve been feeling sick at home, but once you walk into your doctor’s office, all those symptoms disappear.
Going to see a health care provider while you’re not actually experiencing otherwise bothersome symptoms can be challenging. What if your doctor doesn’t believe you? What if they can’t adequately treat you?
These concerns can be even bigger for people with long-term health conditions.
“Unfortunately, many individuals with chronic illnesses may feel the need to amplify their symptoms to ensure they are taken seriously by health care providers, a phenomenon often driven by the fear of being dismissed or gaslit,” said Matt Glowiak, a clinical faculty member at Southern New Hampshire University’s mental health counselling program.
He’s heard numerous stories in which patients are misdiagnosed or dismissed because their provider can’t discover the root cause of their problem.
“This vicious cycle continually negatively impacts the mind-body-spirit pathway, worsening all aspects of health,” he added.
These situations can leave us with a host of feelings, from confusion to irritation to worry. Why does this happen? Should you just cancel the appointment? Here’s what could be going on:
Symptoms naturally fluctuate.
The fact you happen to feel better at the doctor’s office could be a coincidence. “In some moments, symptoms may present as quite severe, while in others, they are seemingly dormant or non-existent,” Glowiak said. “This is completely normal.”
Thankfully, health care providers do (or should) understand this. “Symptoms may come and go, and we can’t expect them to commence on command just because we are in the doctor’s office,” said Dr. Katie Deming, a radiation oncologist and TEDx speaker.
“As a doctor, I am not surprised if my patient can’t reproduce their symptoms in my office,” Deming added. “It is my job to take a full history to understand the problem and help the patient find a solution, regardless of whether the symptoms are present during the visit.”
Your mental health can affect your symptoms.
Sometimes (not always!) physical symptoms are the result of feeling stressed, for example. That doesn’t make those symptoms any less of a problem or less real — it might just explain why they come and go.
“Even somatoform symptoms — those with seemingly no medical cause — do negatively impact people,” Glowiak said. “Mental health complications impact physical health negatively, similar to how a positive mindset is healing.”
In other words, when your stress goes away, symptoms like nausea, rapid heartbeat or other discomfort might go away, too. For some people, this can happen at a doctor’s office, when they’re surrounded by others who can help.
You have a lot on your mind.
You may have to squeeze your appointment into a busy day that’s distracting you from your symptoms.
“You may be rushing to get to the office or Zoom call right after you finish work or get the kids to where they are going,” said Katherine Danley, a licensed clinical social worker with Thriveworks in Tampa, Florida. “Your mind might be somewhere else.”
You’re worried your symptoms aren’t a big deal after all.
Trying to reassure yourself that you’re “fine” compared to those with worse problems can make you minimise your symptoms ahead of your appointment.
“Most people feel that their experiences are not ‘as bad’ as others and sometimes not worthy of being brought up,” Danley said.
You may worry your therapist will judge you, she added, or you may feel uncomfortable with the vulnerability involved in a health care appointment.
What To Do
Keep a symptom journal.
Glowiak recommended tracking patterns and triggers, including photos, videos and audio recordings of your symptoms, if possible. “This can provide concrete evidence for discussions with the health care provider,” he explained.
Deming suggested answering some questions about those symptoms, too, including:
- When do they occur?
- How long do they last?
- Are they associated with any other activities (exercise, meals, lack of sleep, work)?
- Is there a pattern? Do they occur regularly or occasionally?
- Are there any stressors that could be related to these episodes?
“The clearer you can get on the actual symptoms and when and how they occur, the better you will be able to articulate the problem,” she said.
Get as much out of the appointment as you can.
Deming said she’s had countless sessions where a client came in saying they had nothing to talk about, but their session ended up being one of their most productive.
If you’re feeling better, she said, try using your appointment to delve into concerns you haven’t had time to before, or re-evaluate your goals and consider what’s been helping (and not helping) you lately.
Update your doctor.
Some health care practices have web portals where you can message your provider. Don’t be afraid to use them.
“After your appointment, following up with additional information or questions that may have arisen can help ensure that the health care provider has a complete understanding of your situation,” Glowiak said. “Do continue making notes and/or recording symptoms as time progresses.”
Be patient and honest.
While sharing your experience of the symptoms is important and helpful, Deming encouraged letting your doctor ask whatever questions they have, too — even if they seem random or unexpected.
“I know it may seem like they are heading off in an unrelated direction sometimes, but they are putting together symptoms in a way that helps them paint a bigger picture of the problem,” she said. “When I see patients who don’t allow me to ask the questions necessary, it can impair my ability to give the best assessment.”
Don’t doubt or discredit yourself.
Remind yourself that your feelings and struggles are valid, and that your provider should validate them, too.
“Remember that our job is to be non-judgmental and to help you get through anything that you are dealing with,” Danley said.
Bring a loved one with you.
Can a roommate, family member or friend vouch for the symptoms they’ve noticed? See if they can come with you to the appointment, even if you expect your symptoms to be present when you arrive. Glowiak said this can be helpful.
Be present.
This tip is especially important on those busy, distracting days.
“Take a few deep breaths and think about being present in the session,” Danley suggested.
Lean into the feeling of being in your body. In therapy sessions, a feelings chart can help with this, Danley said.
Ensure you feel comfortable and heard by your doctor.
Medical gaslighting is real. If you feel like your health care provider never seems to understand or help you, consider trying a new doctor or practice.
“Healing is more than just nailing the right diagnosis,” Deming said. “You want to find a doctor who makes you feel important and valued… There are studies that show feeling cared for by your doctor shortens hospital stays and improves clinical outcomes.”
Further, that strong, trusting relationship can eliminate or reduce any need you may feel to amplify your symptoms for validation, according to Glowiak.
Try a different type of doctor.
Explaining your symptoms and feeling like it’s not clicking? Doctors can get stumped, too, regardless of how intelligent they are. In this case, seeing a different provider or type of provider can help.
“Given that there are numerous conditions with minimal prevalence, it is realistic that professionals will struggle with diagnosis and treatment,” Glowiak said, adding that a specialist’s support may be required.
Find a patient advocacy group.
Experiencing all of this can feel isolating, but that doesn’t mean you’re alone. Glowiak recommended seeking support from patient advocacy groups or mental health professionals who can provide tools for coping.
“If you are suffering but being told that you are perfectly fine or that there is no root cause to the issue, know that not only are you not alone, you are deserving of support,” Glowiak said. “It may take some time and effort, but help is out there.”