I went to my family physician for a routine physical last week. I hadn’t had one in a while, so I decided to get the exam and requisitions for the usual blood work.
This doctor is one whose opinions I respect. But I never hesitate to speak up when information I have leads me to question those opinions. One topic we’ve had discussions about is insomnia and sleeping pills.
I use Ambien rarely now—sometimes only half a pill—and I’ve still got plenty left from the prescription she wrote last year. So I didn’t plan to mention sleeping pills or insomnia because I didn’t need to.
In the Consulting Room
The nurse sat down at the computer to update my medical record, asking about medications and supplements.
Yes, I was still using Ambien. No, I didn’t need a refill.
The nurse then walked out and the doctor walked in.
So what could she do for me today?
I explained the routine nature of my visit and that I wanted the usual blood tests.
She listened to my heart and lungs, placed her fingers under my jaw to feel for lumps, checked my ears and throat. She verified that my weight was stable and that I was getting regular exercise. She typed the lab requisitions into the computer and said I could pick them up on my way out. Then she left.
After the Consultation
Putting on my coat and boots, I happened to glance at the computer, where my medical record was still open. Three words jumped out, the only ones in bold red letters at the top right side of the screen: CHRONIC INSOMNIA. ANXIETY.
The sight was jarring. These words—diagnoses my doctor and I had talked about—felt like accusations. Why, at that moment, did everything I’d learned in my years of studying insomnia—its association with hyperarousal, the stigma attached to it and other disorders involving the brain, the work I’d done to learn to manage my sleep—fly out the window and leave me feeling bad about myself?
I scanned the record for other diagnoses and found one. It appeared in regular black type on the left.
A comment made by a friend of mine suddenly came to mind:
“Usually doctors are hesitant to prescribe sleeping pills for regular use,” she said, “and I’m hesitant to ask. Having worked in a medical office, I think that when you ask for pain pills a lot, or sleeping pills or muscle relaxants or anti-anxiety things, that’s a red flag for being a drug abuser.”
A red flag for being a drug abuser—was that why chronic insomnia and anxiety were at the top of my record in boldface and red? Because several medications used to treat sleep problems and anxiety are controlled substances and I use one? After decades of responsible use of sleeping pills—never using more than a few at a time, never developing tolerance or dependency—am I still seen as a potential drug abuser by my doctor?
The Question Not Asked
Later another thought came to mind. Chronic insomnia is the first thing anyone would see in my medical record, so why had the doctor not asked about my sleep?
I can’t exactly fault her for the omission. She may have assumed, since I didn’t raise the issue myself and didn’t need a sleeping pill prescription, that my sleep must be fine. She may have remembered other conversations we’ve had about my sleep problem—conversations involving some emotion—and decided to leave well enough alone.
All the same, it would have been nice if she’d asked about my sleep. In my imagination, that conversation would go something like this:
Dr: So how’s your sleep these days?
Me: Never better.
Me: Yes. With all the study and experimentation I’ve done, I think I’m managing my sleep about as well as a person prone to stress-related sleep disturbance can. There’s not much backsliding these days.
Dr: That’s wonderful. That’s an achievement.
Me: Yes. It is.
Does your doctor routinely ask about your sleep?