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I am an adoptee. I was adopted when I was few months old. At the time of this encounter with a doctor, I did not know anything about my birth parents other than they were both teenagers when I was born.Every doctor I have ever seen has asked for medical history from my biological family. My primary physician that I had for several years had recently retired and I had to find someone new. A coworker had recommended a particular doctor, so I signed up to have him as my PCP fir the purpose of my insurance plan. I had no immediate need to see him, however I was pregnant at the time and my obstetrician was taking care of anything I needed at that time.After my daughter was born, I decided to get acquainted with my new doctor. I made an appointment and was given the usual clipboard and forms to complete. Of course it asked about family medical history and as usual, I left it blank.When I was called into the exam room, Dr A asked me why I left the history portion blank. When I explained that I was an adoptee. He glared at me and told me that in his native country (India) that being adopted meant that you were a discarded, unworthy person who was the lowest of the low. I was essentially told by this doctor that I was equivalent to a piece of fecal matter.I was in shock and didn't say a word. Being only a few weeks postpartum, my moods were a mess. I stayed for the appointment and cried as soon as I reached my car.I really wish I had reported this man to the board of medicine. I have never been so insulted by anyone ever in my whole life. I didn't have time to locate a new doctor since I was a new mom and was soon returning to work. I had to endure this man until I could find someone else who was accepting new patients.I am so glad that I will never see that awful man ever again.

Several points, I believe:They don’t understand what major depressive disorder is. They may think it’s sadnessThey don’t understand the physiology of depression, and that it’s due to brain dysfunction.They don’t see depression as a psychiatric disorder, which it is. Calling it a “mental illness,” “mental health issue,” or some other euphemism, trivializes the nature of the condition, and leads people to believe that anyone with a “mental health” designation is the proper person from whom to seek treatment.Most people don’t understand that a thorough evaluation is first necessary, before a diagnosis can be made, and that can’t be made about oneself. It must be an objective third party. Most people assume they have a depression, and then immediately seek a treatment option, such as some form of psychotherapy.Most people don’t know what they don’t know. They don’t know that they may have bipolar disorder, low thyroid, alcohol related problems, medication induced problems, cyclothymia, and so on. There are an enormous number of conditions and situations that I rule out with every new patient during the one and one half hour initial consultation that I do with every new patient. Their entire medical history, social history, and so on.They think that antidepressants are no more effective than placebo. They don’t understand the nature of clinical trials is to use the lowest dose that separates from placebo to get the medication approved. In clinical practice, we use higher doses, along with adjunctive treatments, and get much higher remission results.They think that medications should “cure” these ailments, and they don’t. Very little in the field of medicine cures anything. We do a good job of treating the illness. Eyeglasses don’t “cure” nearsightedness, since the cornea doesn’t “learn” how to see better. Neither does the brain.Most people don’t understand how the brain works, so they don’t understand what happens when it doesn’t. The physiology of major depressive disorder is complex, and the result of genetically inherited vulnerabilities that cause dysfunction in various brain circuits.Major depressive disorder is the condition we are referring to when we use the term “depression.” Not sadness, not grieving, not loss, not a bad day, but a bona fide brain illness.

What I thought would be common knowledge for this physician-patient turned out not to be.A medical oncologist I work with named Dr. Smith called about a patient with a relatively uncommon form of cancer called a MALT lymphoma. He told me that the patient, Dr. _____ had recently retired after many decades at the Mayo Clinic. He moved back to our city, because his daughter lived here with her physician husband.At the appointment, I introduced myself to Dr.______ along with his wife and daughter. I began by reviewing his history. I do this when I am first seeing a new patient to make sure they understand the situation we are addressing. I had talked for a few minutes when Dr.____ asked “Now what’s the duodenum?” I’m sure my surprise was evident in my facial expression as I tried to think of what to say. During the pause, Dr.____’s wife said “maybe Dr. Smith didn’t clarify that my husband has a PhD in economics - he worked as a hospital administrator at the Mayo Clinic”. Just a little embarrassed, I started over with the vocabulary I would use for a “non-physician” patient and the consult continued.