Alice Kelvin is a psychotherapist in private practice in New York City, as well as a thyroid patient. Given the controversy over Dr. Weetman's editorial dismissing thyroid patient with symptoms but so-called "normal" results as having "somatoform disorders " (hypchondria/psychosomatic symptoms), I asked Kelvin to comment on the issue from the perspective of a therapist.
According to Kelvin, she was in a public place when she read the first line of Weetman's article, which says: "There seems nothing more straightforward than the treatment of hypothyroidism."
"I had to laugh out loud!" says Kelvin." Because as I was reading, I thought the exact opposite was correct! Nothing is less straightforward, after my own experience of many years of trying to get my thyroid treatment stabilized."
Kelvin feels that there are number of areas of concern in Weetman's editorial.
First, Kelvin found his comments demeaning and distancing to thyroid patients. She says:
The whole tone is very condescending. He is talking "at" patients -- not "to" patients. When people say "that's all in your mind," they are saying that "there is no reality to what you're saying." He takes a big eraser and says to patients, "you don't count, your symptoms don't matter. Your lab value says you're fine." It's like erasing someone.Second, says Kelvin, is his eagerness to shift the responsibility to the mental health arena.
He's not a psychiatrist, he's an endocrinologist, but he leaps right into the world of psychiatry. He's very quick to take these symptoms out of the traditional medical arena, and put them it into the psychological arena. I don't think that is where these symptoms belong. I think to say "it's in their heads" is a self-protective mechanism, actually. When I've encountered doctors who do this, it's because you don't fit into their definition, and so they say, "see ya around."
Third, according to Kelvin, Weetman has failed to do even the most basic triage; he never addresses the importance of ruling out the other possible causes of these symptoms. Says Kelvin: "You absolutely must do all the tests -- not just for thyroid disease -- to rule out physiological reasons for these symptoms. "
Fourth, he's making patients take on what she calls a "second job." According to Kelvin:
The only thing a patient should be is a patient. But in this sort of hostile environment, being a patient becomes like a second job. You now have to manage your doctor, manage the system, call insurance companies, get referrals, see more doctors -- it becomes a project, it takes over your life. And you're trying to do this while you're not feeling well. No one needs this extra work! It makes a patient's life even more stressful. Eventually, if you've had your second job for a while, you get so sick and tired of being sick and tired that you want to go in the street with a bullhorn, yelling "I want a terrific endocrinologist!!"Fifth, Kelvin feels it's a wrong for Weetman to view what he calls "healthism," as a mistake. Says Kelvin:
I don't think he realizes how out of the loop that sort of a comment is. He's viewing "healthism" as a negative, rather than a positive phenomenon. And it's a trend that has manifested itself in the past five years. What he calls healthism, I call being an intelligent consumer. And that's to be applauded, not complained about. Why would doctors ever complain about an intelligent consumer?I asked Kelvin: If a patient came in to see you, and she was feeling depressed, tired, had a variety of other thyroid symptom, but had been tested and told she was normal by her doctor, what would you tell her?