Tell Me the Part You Left Out
A lot of the women who come in to see me already have some inkling of why they feel the way they do. They're just not completely convinced that's all there is to it, and they're right not to be. Maybe you're under constant pressure to keep everything moving, or sleep hasn't been right in a while, or at some point things got even more difficult and never really let up again. Whatever it is, that's true, and I'm not going to pretend otherwise.
Those all feed into each other too, and it runs both ways. Being worn down doesn't always mean you sleep better. When your nervous system never gets a break, it isn't going to settle just because you finally got into bed. And sleep is when your body does most of its repair work, so a night like that means some of it doesn't get done, and you start the next day with less than you should have. So the things you used to get done without thinking start taking more out of you. It might be one errand that wipes you out for the rest of the afternoon, or a load of laundry that ends up being the only thing you manage that day. When you tell me you're worn out from everything you've got going on, you're usually right about that. What I want to know is what changed, and when, because that helps us know where we need to start.
Your symptoms are information. Your body whispers before it shouts, so a lot of what it's telling you turns up small and easy to talk yourself out of, and you're not the one who's expected to know which of it matters. What hasn't happened yet is anyone putting it all side by side and looking at the whole set at once. There are reasons for that, and I want to go through them with you, because they're worth knowing, and a few of them you can actually do something about.
The reason that follows you from visit to visit
When you have an answer that covers enough of what you're feeling, it can take the pressure off of finding the rest of it. I don't see that as laziness or someone simply deciding that you're fine, it's just what happens when an answer seems "good enough." Once there's something reasonable for everyone to focus on, people tend to relax a bit and start working on that instead of what else it might be.
I see this more often than I'd like. So many of the women I've worked with have been told their exhaustion comes down to whatever they've been facing in their life, and usually they have been dealing with a lot coming at them so it makes sense. And then that explanation follows them from one visit to the next.
That answer ends up in your chart, and everyone who pulls it up after that keeps the conversation going from there instead of starting fresh. I do the same thing, because I need to know what you've already been through and what's already been looked at. It only becomes a problem when what's sitting there reads like the answer instead of one of the pieces, and then something new gets taken as more of the same.
And a lot of the time it really is something ordinary. Being tired is one of the most common things anyone walks in with, and serious illness usually isn't what's behind it. But that's a surface level answer, and surface level is usually where it stops. In my experience there's almost always a root cause underneath it, and it's usually something workable rather than something frightening. That's the part I want to get to.
So when you give me your reason, I take it. I'm not going to tell you you're wrong about your own life, and you probably aren't. I just don't stop there, because an answer that covers part of what you're feeling ends up covering all of it unless someone asks what's missing.
What gets left out before you ever sit down
Sometimes by the time a woman decides to come see me, she's already had the conversation with herself about what's worth mentioning and what might make her sound like she's making too much of it. More than once I've had to pull something out of a patient, and she'll tell me afterward that she didn't want to waste my time on something she figured was too small to matter.
And it isn't always something small. Insomnia is one I see a lot, and by the time it comes up she's usually been living with it for years. She's decided it's her age, and once there's a reason attached to something, it stops being something worth bringing up. By then she often can't tell me when it started either. To her, it stopped being a symptom and turned into something her body just does.
And it's not a decision she makes just once. She's made it before, and each time it gets a little easier to make again. The list of what she'll bring up gets shorter, and then shorter again, and some women even stop coming in at all.
And the ones who do come have usually planned it out further than that. I've even had some tell me they leave their makeup off on purpose because looking put together has counted against them before.
And when you stop mentioning something, it stops existing anywhere but in your own mind. It's still happening to you, it just isn't part of what anyone else has to work with. And you can't put a puzzle together when some of the pieces never made it onto the table.
The call you don't end up making
Say she does bring it up. She's told they'll keep an eye on it, or to call if it gets worse. So she waits. It doesn't get better. Some days are worse than others, but they never seem bad enough that she should call and make an appointment.
And worse could mean almost anything. It's difficult to know if something counts when nobody's explained what she's supposed to be watching for, so she ends up having to work that out on her own. She's left deciding whether it's bad enough to be worth a day off work and a copay and whatever the bill turns out to be, and whether she can stand being the one who came in for nothing. So she waits a little longer. After that happens enough times, most people stop bringing it up at all. Nothing's ever come out of it in the past, and there's only so many times someone's willing to try.
It went wrong earlier than that, though. "Keep an eye on it" is only half of an instruction. The other half is what you're supposed to be keeping an eye out for, and a lot of the time that half never comes. What you get instead sounds more like a goodbye than a plan. Doing all of it takes time, and that's part of why I left conventional medicine.
When I'm not sure yet, I say so. And then I give you something specific you should actually watch for and some idea of how long to give it, and what to do or who to call if it gets worse. That last part matters more than it sounds, because it means you aren't the only one watching.
I don't think most people know there's a second half to ask for, and I don't blame them. If nobody's ever handed you one, there's nothing to notice missing. So what I'd want you listening for on your way out is whether anything came attached to the answer you got. A reason and a next step, even when the answer's a no. And if nothing did, you'd only be asking for what I'd have given you anyway. What should I be watching for, and when should I call. Whatever comes back, you've got something to measure against instead of a feeling.
Every so often a woman hands me a piece of paper with what she wanted to ask written on it, and I like that quite a bit. It saves her holding all of it in her head while I'm talking, and when tiredness is what she came in about, holding onto anything is more work than it should be. And paper has a way of ending up in the chart, which is really the point of it.
None of that applies if something is scaring you right now. I mean the stubborn, unclear kind of thing that's been going on and nobody's gotten to the bottom of. Something that's changing by the day instead of by the month is a different situation, and that one needs to be seen today, urgent care or the emergency room if you can't get in with your own provider.
Where to start from next time
One visit was probably never going to get to the bottom of this anyway, and I'd rather you didn't put that on yourself. What a plan really does is give the next one somewhere to start, so that when you walk back in there's a thread someone can pick up instead of a blank page and a fresh set of questions.
And the piece I'd most want from you is the one you've stopped mentioning, whatever you've decided doesn't count, or already have a reason for, or got waved off the last time you tried. That's the one to bring, even if it seems too small to matter, and honestly especially if it does.
If you go looking and there isn't one, that tells you something too. It means everything you've got has already been said and looked at, and an answer that holds up with everything on the table is a different thing from one that only ever covered part of it.
A lot of what's behind this is workable once the whole picture is in one place, and right now you're the only one who has all of it. That's not a small thing to be carrying, and it's also what makes you the one who can put it in front of someone.
Disclaimer & A Note from a Caring Practitioner:
My goal is to translate complex wellness concepts into relatable ideas to support your journey. The explanations I provide are simplified models intended for general education and motivation, based on both clinical patterns and established wellness principles. They are not complete medical explanations, diagnoses, or personal advice.
Every person's body is unique. Your individual health needs, experiences, and underlying conditions must be evaluated by your own healthcare provider. This information is educational only and is never a substitute for professional medical consultation, diagnosis, or treatment. Always partner with your personal healthcare provider before making changes to your health regimen.
