As a doctor, I appreciate that I am at an advantage when I seek medical care. Knowing terminology and basic medical principles helps a lot. In addition, when you’ve been practicing medicine for a while you get a feeling from how a doctor discusses options if the care seems valid or if a second opinion is in order. Other things I look for are board certification and a doctor who explains their treatment plan in the context of recommended guidelines.
Summarizing everything that combines to make good medical care is very hard. However, from time to time I take unfortunate histories from patients or hear stories of medical misadventures from friends and I just cringe. Actually, they make me want to shout, “Your doctor did/said what!?!?!!” These are red flags, because not only are these recommendations potentially harmful, but if your doctor recommends one thing that is so flagrantly bad, well, uh, um, how can you trust the rest of their care?
So, these are six red flags that would make me stop and not pass go. They would make me get up, get dressed, and say, “Thanks but no thanks,” and walk out the door looking for a second opinion:
1) A prescription for estrogen containing birth control (pills, patch, or ring) with no inquiry about migraines. Why? Migraines with aura are an absolute contraindication to estrogen containing birth control (do to an increased risk of stroke) and if your doctor were up to date on the WHO/CDC guidelines he/she would know that. I want my doctor to be up to date on guidelines, you know?
2) Blaming pelvic pain on pelvic organ prolapse. Prolapse is not a cause of pelvic pain. It causes a bulge, it causes a feeling that something is coming out of the vagina, but it does not cause pain. Any doctor who thinks that the two are related knows nothing about prolapse and even less about pain. And if they want to operate on your prolapse to fix your pain don’t walk out of the office, run.
3) Getting booked for incontinence surgery without a bladder diary (basically measuring everything that goes in and out for 48 hours) and a post void residual (a test to make sure you are emptying your bladder correctly). This simple diary and test can distinguish people who can (and can’t be helped by surgery) as well as indicate some people who could even be worse after surgery.
4) Having concerns about pain with sex dismissed. Painful sex, called dyspareunia, is not normal. Let me repeat that: sex should not hurt. If your doctor doesn’t know that or doesn’t care, move on until you find someone who will listen to your history and do an appropriate exam. There are a multitude of medical conditions that cause painful intercourse and not one of them is, “It’s all in your head.”
5) Getting a prescription for fluconazole (Diflucan) but you also take a statin drug for high cholesterol. These two medications can interact in a fatal manner (rhabdomyolysis) and should not be given together. Especially for a routine yeast infection. In the RARE circumstances where I have a patient with yeast who can only be treated with fluconazole (it’s pretty rare, because there are other options for a yeast infection) I stop the statin, but I really prefer to use something else.
6) Being told your pelvic pain is due to pressure from fibroids. FIbroids are benign tumors of the uterine muscle and they do not cause chronic pain (sometimes when they outgrow their blood supply, they degenerate and that condition is acutely painful, but you can usually pick that up with imaging studies and it’s not chronic pain). Fibroids can cause irregular and or heavy bleeding, but they don’t cause pain. A large fibroid uterus would be 1 lb (most are much smaller, although they can certainly be bigger). If a one pound uterus caused severe daily pain how could pregnancy ever be endured? Think about it.