I dunno. I almost walked out of my first visit to an asthma and allergist specialist because he came across so rude. I was there for allergies, and he came in and said I was so out of shape he could probably beat me in a race around the building, and he's a 50-some guy with a bad knee. At which point I got pissed, told him I hit the gym three times a week, hike, and rock climb frequently. And told him if he was going to say that, he could prove it, and let's go, buddy.
At that point, he backed away from what I had taken as an insulting demeanor, and explained that my asthma was like, go to a hospital bad, according to his spirometer and it was insane that I wasn't reporting subjective difficulty breathing. He said he wasn't trying to insult me, just wake me up to the fact that, yes, my pulmonary function was severely impaired. For real. And I needed to take it seriously. Because there was a real problem. I chilled out a bit when he said that and gave him the benefit of the doubt, but still ready to assert myself if he started being rude again.
I've always had asthma, bad bad as a kid (hospital once a year and emergency doc visits at least once a month) and much better since age 13. I hadn't taken anything for it for years, because it wasn't that bad. I honestly felt my current breathing trouble was mild and not really worth mentioning.
He told me I was sick. Flat-out said that I was sick and that I was breathing at a level most people would head to the ED for. I thought he was being an ass and just trying to scare me into buying his snake oil. Told him I was feeling perfectly fine, which I was, except for my allergies, which my forms clearly indicated I was here for help with. Allergies. Not asthma. My asthma hadn't been problematic in years, with one minor recent exception. What was with this guy, this dick doctor telling me I'm In bad shape and sick when I'm neither thing.
Fuck you doc, prove it: Let's arm wrestle.
Then he asked me to describe the level of asthma symptoms I would consider going to a doctor for, and I told him: blue lips and nails, when I can't catch my breath even propped up in bed, and I'm coughing hard enough that I'm gasping for air. When these symptoms don't decrease in severity for a few hours and sleep and showering doesn't help. Which hadn't happened in years, except for one asthma attack that sent me to Urgent Care three months previously for a treatment and prescriptions for albuterol solution and an inhaler that I requested. I told dic doc that it was nice to have those in case of future asthma attacks, but I wasn't feeling symptoms lately with that one exception.
And I wasn't. Which I asserted to him. And again told him that I was there for ALLERGIES, not his bitchy and off-base judgements on my subjectively asymptomatic asthma.
I was extremely frustrated at his quality of care when he decided to change tactics and prove what he was saying to me.
He went to my chart and pulled out my spirometery results. He went through them with me data point by data point, explaining what each number and percentage meant, writing down averages for the general population and asmatic population in the margin for comparison. He showed me where I could see what percentage of my lungs were too inflamed to work properly and where. He explained that my mostly non-functioning lungs were contributing to my chronic, horrible allergies. I don't remember what the numbers were well enough to include them here, but I can tell you they shocked me. Shocked me. I gaped at the page and the doctor explaining it to me. There it was, the data. Right in front of me, undeniable, unable to be argued with. Facts. Numbers. My lungs were crapped out.
He saw my understanding and amazement and laughed, saying now you see what I'm saying is true. I responded, "But I feel fine breathing-wise. Honestly. I wouldn't even say I'm experiencing noticing asthma symptoms, and you're telling me I'm about to keel over. Could the test be wrong?"
He personally tested me again for free (~$150) with the same results.
I was stunned. I read the result sheet, asking questions about the data where I wasn't clear. He took me back to the room and told me that he's had patients like me before, who grew up with really bad asthma and don't notice or process symptoms as we should as adults. We think everything is normal when really, we should be seeking medical help. We wake up unable to breathe and stuff another pillow under our heads. We see that our lips and nails sometimes get blue and go take a nap to let our bodies rest, or we go rock climbing and just take the blueness in stride, making it a joke when our friends ask. We lay in bed and hear birds chirping annoyingly at 3am before we realize that's our lungs wheezing, not birds.
We don't feel the symptoms like we should, as breathing trouble, he said, because to many adults who grew up with bad asthma, it's just normal not to be able to breathe. It's not consciously noticed by us that we are having trouble getting enough oxygen. We hear the wheezing and see the blue lips and nails and wake up struggling for air and it's not even worth thinking about beyond initial annoyance of getting ourselves back to sleep or finding a way to breathe that doesn't annoy the crap out of us. We think it's minor, mild, and normal so long as we can still function. Who cares if it's a little hard to breathe? We don't, because we don't really notice.
He put me on Qvar to build up my lungs. I'd never been told there were drugs like that for asthma, the preventative kind. No one ever gave me them or suggested them. Within a week, I felt better than I had in years. I could breathe! I had so much energy!! Ahhhhh. Oxygen. Air. I woke up in the morning and didn't spend 20 minutes coughing to breathe right. No bird sounds or labored breathing. My allergies got better too.
Moral of the story--sorry it's so long, it was just a crazy thing to learn after over two decades of living with asthma--is that I walked out of there much better off. The doc had given me facts. Real help. Accurate information. Relevant information. Improved the quality of my life tremendously, and he's probably one of the best that I've seen. But I still almost walked out of that room within the first minute because of his initial approach. Which would not have been in anyone's best interest.
Tl;dr: Doctors can be amazingly helpful, but if they're rude in their approach, they can't expect patients to block that out and listen to their wisdom. I'm not going to pay to sit and be insulted, so talk to me like a fairy intelligent person and not like you're the bully who used to tell me I looked like a boy, and maybe we'll get somewhere.