I learned some important lessons in New Orleans. The most important lesson was to completely trust what my patients were telling me about their bodies and the pain they were experiencing.
I had one patient in particular who came to see me six weeks after she had surgery with another physician. She brought in the operative report that had been dictated by the surgeon. The report said that she had a normal pelvis – no evidence of endometriosis. I had the report in one hand, stating that she had no endometriosis, and her sitting across the desk from me saying, “Dr. Cook, I am not a doctor, but I live with my body and I am telling you something is wrong. Will you please do another surgery on me and look for endometriosis?” I looked at her and looked at the operative report. I agreed to perform a laparoscopy to double check for endometriosis. After all, if there was nothing, a diagnostic laparoscope is a brief procedure from which a patient recovers quickly.
I did the laparoscopy. She had endometriosis all over the place. I was astounded. I removed the endometriosis and her pain went away. What a success story! What if I had not trusted her? Many physicians would have started blaming the patient or would have thought her pain was originating from some other cause. In the years that I have listened to patients dealing with this disease, this lack of trust in the patient seems to be a significant reason why patients are invalidated and do not receive the correct treatment, thus remaining in pain. I believe that trusting the patient is a critical factor in caring for patients with endometriosis and pelvic pain.
You might ask, “How could a surgeon miss endometriosis like this?” It is easier than you might think. It may seem that looking for endometriosis is like opening a door to a room and looking inside to see whether there any pictures hanging on the wall, but it is not that simple. It is more like trying to find a quarter in a bed when the bed sheets are all messed up. Unless you pull the sheets straight, it is easy to miss the quarter. Endometriosis is a tumor, it can have a lot of different appearances, and you have to be methodical to find it all. I had refined my surgical techniques and was using wide excisional techniques to remove all of the endometriosis, in contrast to the burning or coagulation of endometriosis. Proper diagnosis and complete removal of the endometriosis provided success where others were unable to fix the problem. Unfortunately, complete surgical removal of the endometriosis is often not all that the patient requires. Pelvic pain and the health care issues that endometriosis patients often present require a multi-disciplinary approach to address all of their health care needs. This includes disciplines outside of traditional medicine as well as other medical disciplines, such as urology, GI, and pain management. Other disciplines may include physical therapy, Functional Medicine, nutrition counseling, mind/body medicine, sex-therapy acupuncture, and other treatments. How I treat patients is continually evolving as our understanding of endometriosis and related diseases develops.
With a thriving practice, I decided to move back to California, where I started my own practice with the vision of a new paradigm in health care. I wanted to create a health care center where women are listened to, their disease process is understood, and the whole range of effective treatment options are embraced and utilized. At Vital Health Institute, women are respected and included in their health care decision-making process.