You are not “fine.”

I’ve been reading through more medical records, and I am seeing a recurrent theme: “I’m fine.” “I’m doing well.” “I’m great.” Really? Because from the rest of the medical records, you are not fine.

Why do we say we are “fine” when we are not?

Habit: “How are you?” “I’m fine.” – “What’s up?” “Nothing.” – “How you doin’?” “Good.”

Don’t say it to a medical professional if it is not true. Before you walk into your doctor’s office, take a mental inventory. Do you hurt anywhere? Are you depressed or anxious? Have you been having more headaches? Are you gaining a lot of weight since the last medication change?

The 15 minute appointment: A lot of doctor’s office a lot the amount of time a doctor can spend with each patient. Especially doctors who take low-income insurance like Medicaid. It doesn’t mean they are bad doctors, but it does mean that they limit their contact with patients. When we know the doctor has little time we fall back on habit. They ask, “How are you?” and we fall back on habit, “I’m fine.”

If a doctor has limited time to be with a patient, they are not asking “how are you?” for no reason. It is an opening for you to tell the doctor how you are feeling and what is wrong. Assume the question is the doctor being efficient not social.

The efficient doctor: Often when we meet someone, we sense their aura (for lack of a better word). A frantic person brings a level of energy with them that others respond to. An all-business doctor who comes into an examination room and asks three questions while pulling out gloves and glancing over a chart has an authority. Sometimes the doctor is already listening to our breathing or taking notes about our condition before we say anything. So when the doctor asks, “How are you?” We answer, “Fine.” Maybe it is because we feel like the doctor is not listening, maybe we do it because we trust the doctor is ready to do the exam needed to cover our issues, maybe it’s because we feel like his time is too valuable to take up with honestly answering the question, maybe it’s because we are so ready to leave the doctor’s office that we don’t want to slow things down, or maybe it is for some other reason.

Don’t be intimidated by the doctor. If the doctor asks, “How are you?” assume he is asking it for efficiency and answer the question thoughtfully.

Trust: This happens a lot when I am talking to people in mental health treatment. They develop a level of trust with their counselor, and when the counselor asks how they are doing, they answer. When they go to the psychiatrist to have their medications changed, they don’t have the same level of trust. They believe the psychiatrist only cares about the medications. They are not there to talk about their problems just the medications.

Why does it matter if we say “I’m fine?”

What you tell your doctors appears in the medical records. There is a standard form to many medical records. SOAP (subjective complaints, objective observations, assessment, plan of treatment). The first section is the statements you make to your doctor.

The statements you make over time add up. Let’s say once every two or three months you complain to your doctor about back pain. Occasionally, you have an office visit where the back pain improves and you comment about it. Twice you complain about a shooting pain that runs down your leg to your knee. Every visit when the doctor asks how you are doing, you say “fine.” Despite regular complaints and even notations of improvement, the overall effect is that you are functioning well. Afterall, you are doing “fine.”

Doing fine does not translate well. Let’s say you are doing fine because, for the last week, your pain has been managed by laying on the couch and taking ibuprofen. One day, you even felt well enough to make dinner and sit at the table with your family. For you, you are doing fine.

• I was “fine” yesterday. I woke up 30 minutes before my alarm and spent an extra few minutes in the shower. I had coffee and time to talk with my husband before work. At work, I finished everything I had to do and talked with a few co-workers. When I got home I cooked dinner and did two loads of laundry, took my dog for a walk, and played a computer game for about an hour.
• If we both were “fine,” how does a judge know the details behind what “fine” means.
• If we are both “fine,” how does a doctor know what to look at.

Saying “fine” is not specific. I have been going to the same doctor since I was born. He is a general practitioner. I like my doctor. We laugh and get along well, but when I am in his office, it is clear to me that he does not have my file memorized. I often have to mention the same symptom two or three times before he responds to it. Often, when he responds it is because he sees his note from the previous time. I don’t assume that he knows me and all the things we have talked about before. I can’t remember what I ate yesterday much less the medical records of a client six months ago. That is why I take notes. That is why I try to reread my notes when I have scheduled appointment. I always assume I will need to remind my doctor. It’s when he asks how I am doing that I give him updates and give him the first reminder.

It is in your best interest both for a disability claim and for your health care to stopping saying you are fine. If there is a time to complain about your aches and pains, it is when talking to your doctor. Don’t be shy about it. If a doctor doesn’t know what is wrong, he can’t help.