Essay — From the April 2014 issue

Diagnose This

How to be your own best doctor

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The patient, a forty-four-year-old female, presents with ringing in the right ear. She describes her situation to the doctor using as few words as possible. She hopes to signal, via her narrative concision, that she understands and respects the doctor’s time constraints.

The doctor asks a few follow-up questions. Do you suffer from migraines? Yes, the patient suffers from migraines. Are you dizzy? Not dizzy, the patient says. What she feels more resembles occasional motion sickness.

The doctor looks in the patient’s ear. “You may be in the very early stages of Ménière’s disease. Don’t look it up online,” she says, not joking. “Let’s schedule a hearing test.”

Albinus Plants (Tab VII), courtesy Marvin Ross Friedman Collection. All collages by Balint Zsako.

Albinus Plants (Tab VII), courtesy Marvin Ross Friedman Collection. All collages by Balint Zsako.

As the receptionist processes the patient’s co-pay, the patient googles “menieres disease” on her phone. Bilateral hearing loss is involved, as are “severe, incapacitating, unpredictable” vertigo that can last for hours and tinnitus that “disturbs your sleep.” Because of its chronic, untreatable nature, the disease is likely to cause stress, anxiety, and depression. Had the patient — who until six months ago had never been sick in her life — not recently been misdiagnosed with interstitial cystitis, a chronic and incurable inflammation of the bladder lining, about which an online sufferer quoted her doctor as saying, “It won’t kill you, but it will make you wish you were dead,” she might have panicked. She might have believed the doctor. As she’d done the last time she’d been given a living death sentence by a medical expert, she might have wept as she walked home through the park. Because she knows better, she does none of these things.

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is the author, most recently, of The Vanishers (Doubleday), and a founding editor of The Believer.

More from Heidi Julavits:

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  • Annemarie Jutel

    What a beautifully written, and insightful essay. As Heidi Julavits has artfully shown, diagnosis is about much more than just physical ailment. Diagnosis has a (under-recognised) powerful social role, and has just-as-powerful social consequences. The way we think about health and illness, the reasons we consult (or are consulted), the choice of specialist, how both lay and professional communicate amongst themselves and between one another (and more!), all hinge on the power of naming. And, let’s not forget the means by which these diagnostic labels are arrived upon at a collective level. The International Classification of Diseases (like the DSM) is a negotiated, political document wherein diagnoses are stored for future use. As a writer, Julavits has rightfully focussed on story and narrative. As a sociologist, I bring to the fore the important social structures and practises that diagnosis imposes on the practice of Western medicine, and the experience of health.

  • Jill Ensley

    “But a diagnosis is not what she really wanted. What she really wanted
    was reassurance that her future visits to doctors won’t always involve
    an act of deceit, won’t require her to pretend she doesn’t know anything
    about her own condition, or to feign respect for a doctor’s supposed
    expertise while silently knowing that there are many other doctor and
    patient testimonies that contradict or complicate his or her opinions.”

    Thank you, thank you, thank you. I have an appointment with yet another doctor tomorrow and my trepidation stems not from the diagnosis or the illness itself, but from the fear that I will spend another twenty minutes trying to convince one more medical professional that I’m not making these new symptoms up. I have one doctor who listens and it is a godsend. I want answers, but I also want to be heard, not dismissed. I want options. The description of pathways and protocol were spot on and I’d never looked at it that way, but it’s so accurate. Sometimes I think I need a detective and my own personal advocate (for when I can’t do it myself) rather than the almighty “Specialist”.

  • Karen Cormac-Jones

    I would venture a diagnosis of vestibular neuronitis, which would mean someone (a doctor? is there a doctor in the house?) would have to look deeply into your eyes and check out your irises. I haven’t seen a doctor in over 9 years, and will not unless I am delivered in an ambulance after a catastrophic auto accident…they are bad for your health.

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