When seeing a physician, EI (Environmentally Ill) patients will too often give detailed descriptions of their disease, just as they may describe it to a close friend. Although this is understandable from the point of view of the patient, it is unacceptable to the doctor. And more importantly, this striking difference between EI and other patients triggers unwritten rules in medicine:

1. Multiple complaints, often referred to as "long laundry lists," are evidence of a psychiatric problem, and

2. Patients know nothing about medicine.

In view of these frequent problems, I offer some guidelines that may alleviate this problem. (Note that they are the same rules that you followed BEFORE you had EI):

1. Treat the physician as if she/he is in charge -- because he/she IS! HE/SHE writes your report. Remember that if you feel upset with a person, it will be sensed and damage your relationship with that person. A chip on the shoulder begs to be knocked off.

2. Give short answers to her/his questions, preferably "Yes" or "No."

3. Only express your really important symptoms -- no more than 3 or 4 symptoms at most, fewer if possible. (In general, respiratory, cardiac, and neurological problems are most important symptoms. Pain, infections, headaches, gastrointestinal, and menstrual problems are of lesser importance. Rash, itching, dry skin, and infrequent symptoms are usually considered trivial.)

4. Do not make sweeping statements such as "universal reactor" or "hurt all over," since these trigger the unwritten rules above.

5. Do not volunteer information-- wait until asked. This often means enduring silent periods while the physician is writing notes. DO NOT yield to the temptation to fill this silence. A good report is worth the discomfort.

6. Answer questions from a "worst case" viewpoint. That is, refer to your symptoms when they were at their worst. Remember that no one is concerned about absent symptoms, only their presence.

7. Do not volunteer the CAUSE of your symptoms. If asked what you believe caused your symptoms, defer to your previous physician by responding "my DOCTOR said it COULD be caused by ..."

8. Do not volunteer mechanisms, technical details, your knowledge, or theories about your case, since these trigger the unwritten rules above.

I appreciate your feedback and criticism.

Contact me at:
Tel 415-677-0829 | Fax 415-677-9745 | E-mail brenn@sfo.com

Lew Brenneman, MD, PhD © 1998