Dear Dr. G,

I know that this message is probably unwelcome, and I am sorry that I am selfishly choosing to send it anyway. I have made a lot of progress in my very helpful therapy with Dr. A, where I am working on embracing my natural urge to speak up when I find that I have something meaningful to say, even when it puts me at risk of rejection for rocking the boat, as naturally it tends to do. In that spirit, I am making one last attempt at constructive engagement, because it just feels so much better than pathological avoidance.

I understand and accept that you will do what you please with my message, but I want to know that I have done everything in my own power to share my story with you, so that, if you are so inclined, you will have the opportunity to reflect on it and learn from it. After all, patient experiences are useless if kept in the hands of patients; we have no opportunity to apply these experiences to the care of others. What a waste of knowledge and perspective. And as painful as it can be to hear, I believe that most honest professionals would like to receive more feedback, so that they can be as effective as possible. It is in that spirit, as a fellow professional, that I am writing this letter to you.

First, the good news (for you! not so much for me…) is that you were right to suspect asthma. I will never forget blowing into the peak flow meter over and over in your office, each deep breath triggering a painful cough, because you refused to believe that I was giving it my best. Fortunately, I was able to explain my situation to another generalist. She sent me for spirography testing, which demonstrated a clear obstructive pattern. Apparently, my asthma is so severe that I have the lung function of someone more than twice my age. I am now being treated appropriately for asthma, and my shortness of breath has improved dramatically as a result.

As for the MG, which you will recall was at the heart of our disagreement, I have received three independent confirmations of the diagnosis, one of which was from a world-renowned expert on the condition. As you can see, I took your suggestion, however sarcastic and insincere, to use my personal contacts in the medical field to get an appointment with a top-notch neurologist.

It must not have been easy to hear my accusation that you were making “sexist” comments to me. I know that I probably offended you, and I regret that deeply. However, I must hold firm with the assessment that it was sexist and unprofessional to tell me that the “elephant in the room” was that I must have been overly stressed and harboring a desire to be home with my kids because I was a working mom. Rather than trying to peer deep into my soul, you should have dealt first with my symptoms and tried to provide relief.

In case it is difficult for you to see why this is a sexist way to conduct a medical appointment, it might help to ask yourself whether you would ever conduct yourself this way with a working father. Would you refuse to discuss or follow up on his distressing symptoms of exercise intolerance and overwhelming fatigue unless and until he had effectively reached nirvana in his personal life? And what does this nirvana look like for a man: is it not professional accomplishment and a happy, healthy family?

I took your words to mean that you would refuse to offer the full complement of your services as a doctor to me unless and until I downgraded my lifestyle and career achievement to meet your expectations of what someone like me should want or be able to handle. I perceived those expectations as deriving primarily from my identity as a female parent (or perhaps a psych patient?) rather than from any real familiarity with me or what I am all about.

I was also shocked by your direct and sudden admonition against Googling and fabricating symptoms when I raised “post-nasal drip” as a possible explanation for my persistent productive cough. The implication was that I only knew the term because I had picked it up online in an effort to cook up a bunch of feigned symptoms. Is it even possible to fake a productive cough? Didn’t you hear me coughing in your office? I saw you mark “wheeze: +” in my chart; do you think I faked that, too?

Did it not occur to you that I might just be a smart and thoughtful person, motivated to discuss my condition and capable of brainstorming possible leads to follow? And needless to say, it was condescending and arrogant to imply that I couldn’t possibly have the term “post-nasal drip” in my vocabulary. On the contrary, I would be shocked if any native English speaker with a college education did not.

It would have been terrible enough to treat me with such disrespect and distrust if I was wrong. But it’s all the more galling because it turns out that I was right, about this and everything else: I had asthma, post-nasal drip from chronic sinusitis, and MG. Sounds like a pretty terrible hand to be dealt when you already have brain aneurysms, type 1 diabetes, endometriosis, anxiety, and depression, doesn’t it? But instead of sympathy and swift treatment, what did I get from you? Scorn. And doubt.

Doubt. That pesky seed planted in the mind of every doctor during medical training. What was it about my face, or my voice, or my demeanor, or my medical history, that told you that I was probably the type to feign or exaggerate my symptoms? Too much makeup? Too pretty? Too off-putting? Too young? Too female?

When you dismissed and condescended to me, did you realize that I was an accomplished professional with a hard-won career, much like yourself?

Did you know that I had survived a childhood marred by my father’s opiate addiction? That my teen years were peppered with abusive and violent outbursts triggered by the paranoia and confusion my father experienced upon emergence from one of his near-constant stupors?

I bounced back so hard from those years of hellish neglect that I went on to get two Ivy League degrees. Did you know that?

Did you know that my father became suicidal twice, and my aunt actually committed suicide, while I was in grad school? That I graduated with honors nonetheless, pregnant and with undiagnosed type 1 diabetes and anxiety and depression, just months after undergoing pelvic surgery for endometriosis? That insulin pens were dropped into my lap just one month before I began my professional career and two months before I became a mother? That I buried my father and father-in-law before my baby turned one? And that I was managing to kill it in my career nonetheless?

Maybe, just maybe, I am the opposite of a whiner. Maybe I have fought so hard, and for so long, that my default setting is to push through even the most extreme of hardships. Maybe rather than a faker, I am a fountain of resilience and the queen of surviving and thriving. Maybe I was only sitting in your office because all the resilience and psych treatment and survival skills in the world couldn’t make my nerves communicate any better with my muscles. Isn’t it possible?

I know that I got testy with you and I apologize for that. I can only say in my defense that, if you reflect on it, perhaps you will agree that my distress was understandable, if regrettably expressed, in light of the pain of being typecast, patronized, underestimated, and so completely misunderstood. Do you know how frustrating it was to be forced to clear my way through a tangle of sexist stumbling blocks before getting relief for my profoundly limiting and distressing symptoms, which had appeared at what was supposed to be the prime of my professional and personal life? Do you have any idea how long I had already suffered in trying to find answers and relief? I don’t think you do, because you never asked.

You dismissively told me that you are not a “pure biology” guy. Do you remember that? I am pretty sure you meant that you were taking liberties to assess me with your intuition rather than the algorithmic diagnostic checklists that would have, and should have, led you to the doorstep of MG. But my body is not a gestalt, and medicine is, in fact, about biology. If the “pure biology” approach to medicine is missing anything, it’s an appreciation of the tight connection between autoimmunity and trauma history. My psychiatric diagnoses should have enhanced, not diminished, your suspicion that I might be suffering from an inflammatory or immune-mediated illness of some kind.

I hope that this letter adds a bit of nuance to your approach to discussions of lifestyle factors and your impact on your patients in a “non-biological” sense. People make themselves really vulnerable when they bring their medical problems and suffering to you, and the distress they feel at being dismissed and condescended to can be profound. And I, being human, am not immune to that distress.

And then there’s the most obvious problem, which is that your reaction to me caused you to make an error, to overlook correct and relevant information that I was helpfully and charitably offering to you, and to exert your legal power as a gatekeeping primary care doctor to interfere with my ability to obtain the proper diagnosis and treatment for a serious neurological condition. The diagnosis was quite literally staring you in the face; our whole disagreement was, in fact, over whether it was worth exploring that very specific (and, it turns out, correct) diagnosis any further. So even if I had been emotionally impervious and totally indifferent to the symptoms, there would still have been a problem with the way that this encounter was handled.

Your refusal to engage in a dialogue with me, as well as your lack of curiosity about why I was so convinced that MG was worth exploring, directly impaired your effectiveness as a doctor and caused you to conduct the appointment in a way that was designed to get rid of me, rather than to help me as you were getting paid to do. Do you know how many more months I suffered without access to medication because your repudiation forced me to start back at square one? Even worse, a less persistent patient than myself might still be suffering without relief and in danger of receiving one of the many medications and treatments that are contraindicated for MG patients.

Above all, no matter how testy or unpleasant someone may be, everyone deserves to get the medical care that they need, and no doctor wants to be wrong. Plus, wouldn’t you agree that much of the world’s testiness and unpleasantness could be eliminated if only people were feeling their physical best?

I can tell that you are a caring doctor who wishes to do the right thing. I regret that I have so thoroughly antagonized you that you feel the need to avoid me. You are, of course, free to keep on avoiding me if it serves you. I am in good hands and am finally getting the treatment I need. My only hope is that you will learn from this situation and will try harder not to unwittingly subject other patients, especially women and patients who are under psychiatric care for anxiety or depression, to similarly dismissive and degrading treatment in the future. We all have biases, myself included, and we can only try to work on them and stay open to feedback about how they are affecting us, our relationships, and our professional performance.

Some pretty young mothers who have suffered from anxiety and depression are also ill. Seriously, multiply, invisibly, chronically ill. As a doctor, will you join me in tearing down the barriers that we face in getting access to the care that we so desperately need?