Make a psychotherapy referral with a warm hand-off if possible. Explain that this is not because “it’s all in your head,” but because cognitive-behavioral pain management is pretty effective, for management of stress and anxiety, to process the humiliation, anger, and self-doubt people often experience when a medical person tells them nothing is wrong but this flies in the face of the patient’s experience of their body, to explore different options and decision-making, and because therapists get to spend more time talking with people and sometimes hear information that warrants further discussion with a medical provider.
Different genetic groups have different liver enzymes that may cause a different physical response. I can’t tell you how many black people get called “drug-seeking” when they complain of pain, or that they need a higher dose, especially when they don’t have an ongoing relationship with a PCP who can advocate for them.
Also, women’s pain or observations about their bodies are discounted more frequently. For example, I worked with a woman with intense, unrelenting pain after a uterine surgery. She was treated quite rudely and dismissively for weeks until she passed a metal surgical implement that had been left in her body. Nobody apologized to her–in fact, she was told she had to give it back because it was hospital property. On her lawyer’s advice, she did not. That’s a big example, but plenty of women have their pain dismissed as “psychological.” I’m here to say that women with endometriosis, ectopic pregnancy, fallopian torsion, and enormous fibroids hear this a lot. Sometimes their “histrionic” presentation gets written up in their chart, which makes it very hard for them to be taken seriously subsequently. Many younger women who find breast lumps get told it’s probably just dense tissue or they banged themself, but are refused imaging because they’re “too young to have breast cancer.”
I wasn’t a medical doctor, so of course I wouldn’t and couldn’t diagnose medical issues, but I could notice patterns and discrepancies and, when warranted, ask to speak with the person’s PCP, often with good, collaborative results. This is an ethical responsibility of many counseling professions–medical conditions need to be referred for rule-out, and, I’ll add, this postentially is an ongoing process.
Physical issues I identified by providing more detailed questions and reports to the medical providers of people who had been told nothing was physically wrong or diagnosed as having (only) a psychological issue: MS, Lyme, cancer recurrence, broken vertabrae, toxic medication effects, problematic medication interactions, encephalitis lethargica, Bell’s palsy, celiac, parasitic worms, detached retinas, seizure disorders, Hepatitis B, congestive heart failure, incorrect diagnoses, etc. Plus, of course, there were many people with unexplained pain that received a functional diagnosis, but could be intervened on with a combination of psychotherapy and referrals for complementary physical services. Most of the docs I worked with were glad someone was able to spend more time with their patients, and appreciated both our consultations and the techniques and conversations that I was able to have with our patients. Most would have preferred to spend more time with patients, and I wish they could.
From my vantage point, however, that tiny number can have an outsized impact.