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When Doctors Seem Dismissive

I intentionally titled this post when doctors seem dismissive rather when doctors are dismissive. Most doctors are anything but dismissive. Overall, my doctors have been great, and this post is not intended to be a criticism of any doctor in particular, though I do use specific examples, rather it’s an attempt to raise awareness about yet another important aspect of patient care.

I do believe many doctors appear to be dismissive from time to time for a whole host of reasons. Perception matters.

No matter how great your doctor is or isn’t, one of the things you remember most later on is how he/she listened or did not listen to you. And of course, being dismissive isn’t exactly the same thing as not listening, but they are closely tied.

Having a doctor who is competent is vital, but having one who listens to you and is not dismissive is also important.

After first ruling out a heart attack the day I went to the ER, the attending physician went on, though unintentionally, to dismiss my chest pain. After a brief discussion where I was “reassured” that more than likely my pain was nothing, the doctor left the ER room with almost (perceived by me to be anyway) a flippant attitude, patting my legs and saying something like, these kinds of aches and pains happen to people our age.

Needless to say, I soon began feeling more than a little embarrassed and then guilty as co-payment costs and dollar signs starting flashing through my mind. He meant no harm. I knew he was merely trying to lighten the mood and make me feel better, but he didn’t lighten the mood and I did not feel better. To me, it seemed he was being dismissive.

Then there was the comment often made, again with purely good intent, by so many on my health care team. I can’t tell you how many times during/following appointments, before surgeries and all through treatment I heard the words, you’ll be fine.

Again, this was a completely innocent remark which was supposed to be comforting for me to hear, but I found it to have the exact opposite effect. No one knew things were going to be fine. Saying so felt dismissive, as if my fears were being diminished. Even Dear Hubby sometimes remarked on this very thing. And many times, I might add, his feelings as the caregiver were dismissed entirely, or so it seemed to him.

The day I learned I was going to be having chemotherapy was one of those times when I lost it while still in my oncologist’s exam room. When I point blank announced to him yes, rather dramatically, something along the lines of,  I’d rather have a dozen more surgeries than undergo chemotherapy, he didn’t say anything, but gave me a look that to me said, come on lady, get a grip. Again, it felt as if my fears were being dismissed. I was terrified, and for some reason, I wanted him to understand this. I’m not sure he ever did.

Later at appointments following each infusion, my health status was monitored, of course, along with all the necessary markers and such. In addition, I would be given an opportunity to inform my team of any side effects I was experiencing. While admittedly, my side effects were mild in comparison to those some experience, still, I sometimes felt they were too easily dismissed. They weren’t as bad as they could have been, therefore, I didn’t feel comfortable “complaining” too much, and so I didn’t. Sometimes, as a result, I felt they were dismissed. I felt dismissed.

More recently, I received what to me was upsetting news about my bone health. The side effects of my ongoing adjuvant hormonal therapy have raised some pretty intense havoc on my body. The side effects of this treatment are real, unpleasant and serious and this time, I did not so easily allow them to be dismissed.

The difference now is that I no longer keep quiet because since my mother’s cancer and then my own, I have a lot of experience from the cancer patient’s vantage point. I now express, or try to express, exactly how I feel about things to my doctor. I don’t allow my concerns to be so easily dismissed anymore. I think I’ve earned this right, but I don’t think any of us should have to “earn it.”

A patient should never feel dismissed.

When patients are feeling sick, (due to any reason or cause) they are often also feeling vulnerable. When you’re feeling vulnerable, self-advocating is harder, perhaps even impossible at times. Sometimes it’s easier to allow your thoughts, feelings, symptoms, fears or worries to be dismissed.

If you’re a caregiver, you might feel as if your feelings or fears don’t matter as much or at all, so you simply keep quiet and allow them to be dismissed.

Anyone who is part of a medical team can be tremendously helpful to patients, no matter what the situations are, by merely acknowledging their patients’ feelings, pain, reaction to medications, fears, symptoms, emotional well-being or whatever it might be. In addition, the importance of acknowledging the feelings of the care giver cannot be emphasized enough either.

I understand. I know this must be hard. I hear you. I want to help. I wish I could change this. I’m sorry about your pain. I don’t blame you for being frightened. I’m listening. I care.

Such simple and empathetic words would mean so much to most patients and to most caregivers as well during times of illness or injury.

From a patient’s point of view, or at least from this patient’s, having a doctor who listens to your fears, understands your worries, acknowledges your pain and does not dismiss your concerns means an awful lot.

Sometimes it can mean everything.

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When doctors seem dismissive
Having a doctor who listens can mean everything.




48 thoughts to “When Doctors Seem Dismissive”

  1. When I was going through all of the pain with that tumor flare and had such difficulty walking, I was leaving the doc’s office and I said, “Dammit, doc. This isn’t fair.” And he stopped, looked me in the eye and said, “You know what? You’re right. It isn’t fair at all.” That made me feel so good. He listened to me, empathized, and cared.

    Nobody cares what you know until they know that you care.

  2. I feel my Dr is being dismissive now. I went through 2 ordeals already due to mistakes on the Dr.’s side I don’t want a 3rd.
    I have a large lymph node with my Lymphedema being far worse on my left side than normal. I used to be able to raise my arm and had I would say 95% function overall. Now some things are difficult. I went for scans called the other day. My nurse said there is no evidence of Thoractic metastasis.Whooppeee what about the lymph node?? I am considering changing my Oncologist but since they all work together it may be difficult unless I go out of town. I can’t take a chance on another mistake. This is my life and he is not taking me seriously. I feel dismissed…. Love Alli xx

  3. I took Arimidex for hormone blocking for nine weeks and then I quit. I would rather be dead. At 61 I don’t know how much longer I hve anyway but I am not going to go through broken bones, aches and pains, genital sores, hair loss.

    Come on. I wonder how much of this treatment we really need? I think we all individuallyneed to assess whether we want to do this.
    A good friend is in final stages of breast cancer. What is the point of doing all that chem o and making your family miserable?

    We need to live life when we can, and when to let go ………

    I understand a young woman fighting to have her life. At what cost….its individual.

    1. Bonnie, I know what you mean about the nasty side effects from Arimidex. I’m dealing with some myself. You’re right, it’s about personal choice and every patient must make informed decisions. I’m very sorry about your friend. I’ll be thinking of you both. Thanks for sharing your thoughts.

  4. Had a grabbing left sided chest pain and reported it to the Medical Oncologist (double mastectomy 2010 with chemo and radiation following) He listened and ordered a bone scan–had that on March 7. Called his office for results on March 12, 13, 14. No results given. Then had appt with radiation onc.on March 15 and that office requested that the bone scan report be faxed to them. I asked for a copy and finally got to see the results. Had an appt with the med onc yesterday and let him know that waiting that long was unacceptable!!! Luckily no mets or other major negative findings but waiting is HELL!

    1. Meg, Well, I’m glad to hear the report was good, but you’re right, that was a long time to wait. I’m sorry for the anguish you went through while waiting. Thanks for sharing about it.

  5. The 1st breast surgeon I saw was very dismissive. When I went in for the biopsy she told me I had breast cancer but would have to wait for the results and then sent me on my way. When the results came back she said yes i was right it is breast cancer. Here is a list of appointments to go to tomorrow and we will talk in a week. That was it. If I had a question I would have to speak to her nurse. So glad I went for the second opinion it didn’t change anything but did make me change surgeons. Much happier now

    1. Lexie, I’m sorry your first breast surgeon made you feel dismissed. And to not be available to answer your question herself seems not only odd, but wrong. I’m glad you switched and that you’re happier now. It’s so important to be able to make a switch if things don’t feel right for you. Thanks so much for commenting.

  6. The worst was my former neurologist who belittled my worries about my brain lesions and said he wasn’t my doctor and only cared if I had another seizure.

    1. Acacia, Are you serious? That’s appalling; it seems to me behavior such as that should be reported somewhere. Did he say that because he wasn’t your oncologist? I’m confused a bit as well as appalled. He was still part of your team at the time apparently. I’m sorry you had to hear such a statement. Thanks for sharing though.

    2. I know this is old, but I just had a similar thing happen. I asked my hematologist if we could test for any more things because I had noticed she filled out Q+A’s for me that I had never been asked and had checked 99% of them “no history of…” when in fact, many of them had been things plaguing me for years if not my entire life! I wanted to scream, but I didn’t. I told her some of the things I actually was experiencing, and she gave me a half smile and said, “I mean, you can tell me your symptoms if you want…is it like, joint pain or something? Because if so, I’m really not the person to be talking to.” I felt really stupid at that point, but pressed a bit further and she finally agreed to order one more test for me, which turned out to be positive! Had I not gotten that test, I may have given up or felt like I really was over reacting.

      Another horrible thing docs say to me is “sometimes ‘healthy’ people test positive for these things, so you have nothing to worry about.” Except that I was symptomatic and had almost died the month before as a side effect of an autoimmune disorder that ALMOST got missed. Because I spent hours researching my symptoms myself, I was able to ask for specific testing that I thought that I needed.

      I also was initially misdiagnosed when I nearly died, and wasn’t even tested for numerous things since I was simply a “young, healthy, fit adult who couldn’t possibly have anything too terribly wrong with me…” I can’t tell you how many times I heard before diagnosis that it was INCREDIBLY rare and to stay off Web MD. Well…I am here today because of WebMD so those jokes are no longer funny to me.

  7. Nancy,

    Yes, I have felt dismissed by doctors and, worse, abused by them. Luckily, I fired the ones who were bad news and hired the right individuals to entrust myself to their care. They listen to me and are incredibly open to my narrative.

    1. Beth, Feeling dismissed is one thing, but feeling abused is another thing entirely. I’m sorry to hear you felt that way at one time. Thank goodness you have found individuals you are at ease with. Thanks for sharing, Beth.

  8. I have felt dismissed by doctors for lesser medical issues that pre-dated cancer. One doctor dismissed me when I had reactions to antibiotics. She wouldn’t put me on a different antibiotic, but insisted my reactions were from the herbal supplements I take. I ended up calling my dentist friend who called in a prescription for a milder antibiotic. However, my oncologist and breast surgeon were amazing. They always listened, were patient, empathized and were proactive on my behalf. They were great doctors and even better human beings.

    1. Eileen, Yes, this issue doesn’t just pertain to those with a serious illness. No patient should feel dismisses, no matter what they’re being seen for. I’m pleased to hear your oncologist and breast surgeon have been amazing. Thanks for sharing an example of when you felt otherwise.

  9. Just one bad experience and that was early on with the surgeon. Two tumors in one breast and one tumor and suspected tumors in the other. I knew it wasn’t going to go well when the surgeon addressed his comments to my husband and didn’t even make eye contact with me. He went on and on about how he was going to save one of the breasts and I finally said, “Please explain to me why we aren’t talking about taking both off” and he CHUCKLED. I put my foot down and insisted that they were going to take both and I wasn’t in the mood to screw around. Interestingly enough he came to see me post-surgery and was just great. Maybe he was having a bad day when we did that first consult? Who knows.

    1. Victoria, I don’t blame you one bit for being highly annoyed with that surgeon. It sounds like you did a good job of self-advocating though, and I’m glad the surgeon seemed so much better post-surgery. Perhaps he learned from you! Thanks for the comment.

  10. Great advice you offer to people undergoing care. I am deeply saddened by some of the treatment described by your commenters. There are so many great, compassionate providers it angers me that they are so are so often overshadowed by poor ones.

    1. Paige, You’re absolutely right about the many wonderful and very compassionate providers out there. Thankfully, there are far more of those. Thanks for commenting.

  11. A few years ago I passed what I am sure was a kidney stone. It was not only incredibly painful, the discomfort lasted for days. At the worst point in the pain, we went to the emergency. Throughout the whole process I had a terrible time getting someone to take my distress seriously. In the end, no diagnosis was made, but the pain stopped a day later. (No recurrence thank God!) I agree that it makes it so much harder when everyone around you, even your doctor, says you will be fine. Sometimes knowing and understanding what you are going through helps you to cope.

    1. Jennifer, My goodness, that must have been awful and to not have your distress/pain taken seriously on top of things… I’m sorry about that miserable experience. And yes, the power of simple, but genuine empathy can never be underestimated can it? Thanks so much for stopping by.

  12. Nancy,

    You couldn’t have summed this up better. Though I know I’m in good “academic” hands, often I feel dismissed. Recently, after experiencing unusual floaters and migraines, I nervously asked if there could be a possibility of brain mets. My research nurse actually laughed (I kid you not), followed by “well, yes that’s always a possibility.” Though I believe it was nervous laughter, I can’t begin to tell you how sick I felt leaving that visit. Sick that in an environment where I should feel safe and unashamed, I left feeling helpless and alone.

    Truth be told, I am a patient who RARELY complains and when I do I often feel like I’m apologizing for my pain. With three young boys whose lives I’d love to see unfold, I am now on a survival mission. Being diagnosed at 38 with stage III out of the gate 3 months ago, obviously put a legitimate sense of fear in my entire being. I now vow never to “apologize” for anything I feel or experience during treatment and beyond.

    The most empathetic, moving remark I’ve received from my caregivers at Dana-Farber came from my Nurse practitioner, who looked in my eyes, holding onto my shoulders and said: “Nicole, there are no secrets here. If we feel something is suspect, you will be included in the conversation. You can trust us.”

    It’s a moment like that, a simple, earnest look, a touch . . . that helps you feel truly cared for.

    Thank you for laying out truth for patients everywhere. We are all just looking to be valued and heard through an empathetic ear.


    1. Nicole, This is such a wonderful comment and so perfectly exemplifies both sides of the coin. I love the way your nurse practioner at Dana-Farber handled that moment by answering you honestly, looking directly at you and offering a kind touch. And all that only took only a moment. The way the research nurse in your first example responded to your question and worries, well, that was totally inappropriate IMO. Thanks so much for sharing and adding to this important discussion. And your vow – that’s a good one.

  13. There’s nothing worse than a dismissive doctor. I remember I was with my brother for a doctors appointment and my brother and I had questions. My brother was clearly dying of esophageal cancer and his doctor was so dismissive. He was looking at his watch, impatient and couldn’t get out of the room fast enough. I never said anything to my brother about how upset I was with his oncologist as my brother died about 3 months after that particular appointment. I just could tell the doctor wanted out of that exam room and was annoyed by our questions. Because my oncologist had been so different, I kept my opinion to myself., This was the doctor that he chose and saying anything was not going to help. Still to this day I get upset when I think of that appointment.We all know when a doctor is dismissive. You just know.

    1. Susan, The appointment you describe with your brother sounds simply awful, not to mention unacceptable. I’m so sorry about that. I’m glad your oncologist is quite different. Thank you for sharing about such a difficult experience.

  14. Nancy,

    Patting your legs and saying we have these pains at our age is not dismissive – it’s Patronizing! I had a doctor do that and I felt like punching him!

    Unfortunately, most of my doctors have been dismissive. I told every doctor for the four months after my surgery about my unusual amount of pain. It took a near nervous break-down to get one who listened.

    Now they dismiss me as the one that had the nervous breakdown…

    I can’t win here, it’s plain to see. I had so many dismiss so many things, I think I need to write a book about it.

    Thanks for tackling the tough subjects!


    1. Dianne, I think you’re right about that doctor who patted my legs and made that comment. I’m sorry so many of your doctors have been dismissive – that is so wrong. You’ve had a tough time with things. Thanks for reading and sharing.

  15. I am very fortunate, all of my doctors are incredibly kind and respectful. My oncologist calls me his pearl and makes it very clear that he is only a phone call away, anytime. My breast surgeon listens to my heart and my neurosurgeon tells me that I’m not a statistic, no one is a statistic. They all do their utmost, always. My GP is just the best, period. The only time I left our cancer clinic feeling deflated was when I dealt with a different medical professional who cut me off while I was talking, she said, don’t self-diagnose. I’m always mindful of what is going on, it has saved me many times, and my oncologist appreciates that I’m an informed patient. For the first time ever, I complained, and it was dealt with immediately. You are so right, empathetic words can mean everything. But, I don’t like pity. This person also had a hard time discerning the two. Great writing Nancy, as always. Much love… C

    1. Carolyn, You are very fortunate. How nice that your oncologist calls you his pearl. I love my GP too. I wrote a post about her too! She has helped me pick up the pieces… sometimes I feel badly for her ‘cuz it’s a big job! Sometimes a bit of validation, without the pity of course, goes a long way. Thanks for reading and for sharing this one too.

  16. My husband has been suffering from terrible pain and was recently told that he needs major open back surgery by a neurosurgeon who is highly regarded for his skill in our area (not a major medical mecca). Since the appointment, I have spent countless hours and weeks researching and educating myself by reading scholarly articles (which I understand better than most for reasons I won’t elaborate on) and calling other neurosurgeons’ offices all over the country and collecting information on the subject of his diagnosis because I was unprepared and shocked during the first appointment. I had questions about why he was choosing the particular approach (there are many approaches to this out there and the one he chose would leave my husband missing supporting spinal structures for the rest of his life). If he could have relief with less invasive drastic surgery, I want to know. His office had his aide call me back and he was obviously unfamiliar with any details and said that we needed to make another appointment and speak to the doctor (doctor doesn’t call back). We did. I made a list of questions, but the neurosurgeon was only interested in talking to my husband (non-technical questions) and when he finally “let me speak”, cut me off and even refused to pull up the MRI and discuss the findings. He said that he just knows what to do because of his experience and we could always find another surgeon. BTW, 2 radiologists (one of whom is from Harvard/Mass General) have different opinions than his of the findings on the MRI, which I asked about. His answer was that it is totally subjective and he disagrees. I even offered to leave the type-written questions for him to address and get back to me later if he was too busy, but he wasn’t interested. I am very concerned and my husband just dismisses me too. I’ve come to hate doctors. Most are not willing to take any reasonable amount of time with patients (or their families) and have a “God complex”. The latest thing has become to assign “assistants” (most of whom have no clue or medical education) to screening phone calls. I have seen a few who are great doctors, but most are horse’s @**es.

    1. April, I’m sorry you have felt dismissed. That is always hurtful and obviously unhelpful. All I can say is, be persistent. Your questions and concerns deserve answers.

  17. Yes I have been dismissed by a doctor. I recently left an emergency room without care. I went in because my legs randomly and temporarily stopped working, and I was treated as a drug seeker. It was awful! I still don’t know what is causing the numbness and whatnot going on in my legs, but I’m trying to get in touch with doctors. They didn’t even give me any referrals. Anyway, the whole thing is too much to type in your comments, but my story was picked up and is getting shared around a bit, and I hope I can continue to raise awareness about it until things change!

    Here’s the link where my story got picked up, if you’re interested to read the whole saga.

  18. I was recently diagnosed with Stage2 grade 3 er/pr + Her2 negative
    I had a mastectomy. I had follow up appointment with oncologist to discuss my treatment plan…but it was not really a discussion..she mater a factly stated we will start you on Arimedex. For 10 years….no chemotherapy. I should be happy with her decision no chemotherapy but I am concerned about micrometasties-She wasn’t willing to discuss because the oncotype test came back low risk.When I question that it did not make sense because the tumor was grade 3 she said why would we do the test if we didn’t go by the results…basically she just shut me down. I am seeking a second opinion

  19. My breast surgeon completely validated my feelings and my level of intelligence when, after receiving an OncotypeDX score of 24 (a mid range where the value of chemotherapy was considered murky, at best) I told her (without first hearing her opinion) that I had already chosen not to pursue the chemo. Her words to me were – “I agree and accept your decision.” I felt like I was in charge of my care, even if she would have ultimately said the same thing – I got to say it first.

  20. This was my recent experience. My doctor said I had to go to the ER because of numbness in the right side of my face and an incident I described as a vivid, half-awake dream, and she said was a hallucination. I go to the ER, because she said I absolutely had to go. The doctor there rushes in before I am fully dressed in my hospital gown, before I have put my things away. She starts by asking my symptoms, and then becomes angry with me for not answering an unasked question about which doctor I had seen. (Use your words, maybe?) Then she becomes angry when she places both hands on my body and asks me to press against “this hand”. I do not know which hand is “this hand”. Again, using words would be nice. She wouldn’t let me finish about my actual complaint and kept saying, “So, besides the numbing, what’s wrong?” I mean… nothing? I went in for the numbing.
    She also said that the thing the other doctor said was a hallucination was a dream. So, I don’t know, which is it?
    Then she said that me being anxious about the symptoms caused the symptoms, even though I wasn’t worried about them until after they happened. But apparently time is no longer linear, I somehow caused myself to go numb on the right side by being anxious about it from the future.
    She didn’t do any different tests than the clinic did. The clinic that said that these test were inadequate.
    Then she said I probably didn’t have anything because of my age and because I’m relatively fit (I’m a hiker).
    Well, cool. Probably nothing, then. Great! Of course, my other doctor thought it was possibly something. But, hey, probably is good enough.
    Then she said I was anxious.
    I said I was only there because the doctor told me to be and if she didn’t think it was anything I was happy to go home. In the hall, I heard her sarcastically talking about me and saying I was “adamant” that a doctor sent me. Well, yes, lady, because you were rude and dismissive before I even described my symptoms.
    I also had bloodwork come back positive for some things, but she wasn’t interested in letting me explain that, or my medical history. But, ya know, she left by saying I could have freaking MS and that she doesn’t do anything with MS.
    Cool, cool, cool, cool, cool. That’s fine. That’s fine. You’re fine. That’s fine. That’s fine. It’s fine. It’s fine. It’s fine.
    I’ll probably get charged like $1500 or more for those 15 minutes of condescending nastiness, too.
    And now I can tell my doctor that we still don’t know. I’m done. I literally would rather this be a serious thing and die than ever go back again. Worthless waste of time from quacks with egos.
    Oh, but at least I got asked if I smoked about 950 times. Because it’s impossible to share records and document something, I guess.

  21. So, last week I go to the neurologist’s office for an initial consult to investigate the possibility of a CSF (cerebrospinal fluid) leak post brain tumor resection. These symptoms had been plaguing me for 3 years, and now that I’m finally done paying (through the nose) for the resection, I might actually be able to investigate this issue.

    The PA listened as I outlined my symptoms: clear fluid drainage from primarily the left nostril when up and active, fluid build up in the right ear causing hearing loss, neck pain that won’t go away, and daily bouts of intense nausea.

    The first thing out of the PA’s mouth was “Well I don’t think that you have what you think you do.”

    This sentiment was repeated two more times over the course of 10 minutes.

    My thoughts and concerns were dismissed immediately. Why?

    One missing symptom: headache.

    Now, as I explained to the PA at the time, the neurosurgeon who performed the resection of the tumor also nicked the nerve bundle that the tumor was growing around, thus causing the right front quadrant of my head to be appx. 95% numb forever. I don’t think I can even have a headache now.

    I was still met with “Well I don’t believe it’s …”

    I won’t be going back there. Ever.

    In fact, I’ll probably just forego any further healthcare period. I’m done with doctors and the medical/industrial complex, and I will not feed that beast ever again in this life.

  22. Great info i have lymphedema now going 20 yrs .i hate it but im alive .i live in california when the weather is hot my arm gets bigger . i wear a compression garment boy it is hot. Last yr i tore my rotater cup the lymphedema arm no surgery no relife i needhelp the morethe fluid fills the tears get bigger. Any suggestions. From anyone.
    Good luck everyone ❤

    1. Carmen, Sorry to hear about your LE, the rotary cuff tear and that you’re not finding relief. I can’t offer any medical advice for your situation, but I hope you find someone who can help. You deserve relief.

    2. You know, Carmen, I am having a problem that is similar in that the more doctors dismiss my concerns and actual experience of body-alerts (like pain and unusual visual symptoms), the more I start to panic that I will be left to slowly die of my condition rather than get relief that is most likely available somewhere out there, being hidden by the egos of routine-only doctors. You know, get the status with minimal effort. It would almost make one want to call the ambulance and be unresponsive so the doctors are forced to check for any abnormalities and attend to them. But because that is dishonest, it’s not an option. It feels like taking your car to a mechanic and starting to tell him your problem with the car and he interrupts and says, listen, I’ll put in a new radiator and you can see if that helps. If not, come back in a year. Then he charges you $600.00 and if you go back sooner, you will be listed as hysterical. Anyway, with a torn rotator cuff, your quality of life is severely reduced. I don’t know how the author of this article can be so dismissive… like, I am writing a medical advice article but can’t for the life of me understand what a person with LE and a torn rotator cuff could possibly do for relief. Jesus. I will do a little bit more than the author offered you and that is to seek the help of a healthcare ombudsman. Check out the services of an ombudsman, and if you get any dismissive Doctors in the future, the Medical Board of your state is urging anyone to report these doctors. It’s simply unacceptable and should never require an ounce of effort on the part of the paying customer (conveniently called patients in this field) to be skilled at prompting them to do their damned jobs. You lost 20 years of life by having to panic before doing daily tasks, such as putting on your bra, to say the least, where you didn’t have to even have but temporary trouble in the first place.

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