When Trust Hurts: Doubting your Doctor
Now more than ever, the credibility of health care providers is on the line. The chopping block really. Today, we get to talk with Sam, who lives with chronic migraines and recently faced major doubts about their physician’s ties to the industry and ability to empathize with migraine pain.
MFL: Sam, thanks for coming on.
Sam: Thank you for having me.
MFL: Today, we are going to talk a lot about doubt. Migraines, as anyone who’s had one knows, can be isolating and brutal. Minutes can feel like hours, and weeks or months between doctor appointments (to me) feel like there is no light at the end of the tunnel. Tell me, what’s that moment like when you first started thinking your doctor is just seeing you because its “a paycheck”?
Sam: It creeps up slowly. I’d read about doctors secretly taking money from companies and wondered: Is my doctor listening to me or just pushing the latest drug? And—this is the big one—my doctor doesn’t even have migraines. I wondered, how can they possibly “get” what this does to my life?
MFL: You’re describing something I’ve heard in other interviews. One patient told me, “When my doctor dismissed my fatigue, I stopped telling him the truth.” Others say industry ties just feel “dirty”—even if their doctor seems kind to them. Did you feel this tension building up over multiple visits?
Sam: Absolutely. It all started at the beginning of the pandemic. They were trying to see patients virtually, which was fine for me to be honest. But I started reading about all these treatments you could take to prevent COVID-19. Ivermectin and hydroxychloroquine. I was a biology major, so I looked into these things and thought, “what bullsh-t”. There’s no way these drugs would work. So my mind went down this rabbit hole from “who’s trying to get us to take these drugs?” to “who’s profiting off this garbage” and eventually “isn’t this just what Big Pharma does?” Every new prescription or treatment option, I’d question, "Is this about me or about some other agenda?" I dreaded appointments with Dr. ——. I could feel my trust in her was dissolving.
MFL: Did you ever fear that raising these concerns might make things even worse? Some patients I’ve interviewed said they delayed talking for years because they worried about being “difficult” or “ungrateful.”
Sam: That was me, totally. I thought if I challenged my doctor, the relationship might never recover. But I didn’t want to keep second-guessing everything.
MFL: How did you finally bring it up?
Sam: I tried to be honest. I said, "I know you do a lot of research, and I’ve read things about doctors in research. I feel nervous that maybe there’s some outside influence—especially since you don’t have migraines, it’s hard to feel like you get it." I don’t remember if I specifically brought up money, and maybe I didn’t say it as nicely as that. It was awkward to bring up but also a relief.
MFL: That’s brave. Some interviewees say their doctors “shut down” or brushed off concerns—one even said her doctor called her “paranoid.” Did your doctor get defensive?
Sam: No, that’s what surprised me. My doctor was so open—she explained exactly where their research funding came from, even pulled up a budget she has for one of her trials that she submits to the NIH—where the money goes, and so on. I remember seeing these huge numbers, hundreds of thousands of dollars, and thinking “boy, she is raking it in.” But when she showed me what she gets out of it, it was like 5% or something. And I remember her saying it’s not like she gets this money extra. It was like it paid for one of her clinics or something, giving her time to do the research.
MFL: Was your doctor’s transparency reassuring? Or did it feel like just another “official answer”?
Sam: It actually helped. But what really changed things was the personal story she shared. They told me about growing up with a younger sister who had migraines so severe she missed entire semesters, sat at home while my doctor played sports, skipped prom—she said those memories drove her into medicine, specifically to treat patients with headaches. She wanted to be the doctor her sister never had.
MFL: I’m honestly struck by that. I’ve heard other doctors try to relate—I remember one who confessed he didn’t understand pain “until a spinal injury woke him up.” Personal stories really do break down walls. How did hearing about your doctor’s sister change your feelings?
Sam: I realized I’d made assumptions. This doctor carried pain—not personally, but through her family. When she teared up telling me, I believed her. Suddenly, the industry stuff and research… it made sense. She wants migraines to have a cure, for her sister and for patients like me.
MFL: Still, something you mentioned really stays with me—the worry about having “fractured” the relationship by being so blunt. Did you talk about that with your doctor?
Sam: I haven’t… not yet. The truth is, patients see so much negativity online and in the media about “greedy” or “cold” doctors, it’s easy to forget most went into medicine to help. I remember how a med student was with Dr. —— one day and they just started talking jibberish about my MRI and the symptoms I had described. She saw how puzzled I look and said she would explain it all so I could understand. But medical students like the one she was with have to learn 4 or 5,000 new words during med school. And they have to learn empathy, examination skills, and other things during their training. Then they have years of more training, some even spending 9 or 10 years after college in training before they become real doctors. That’s an insane amount of time to waste if you’re just trying to make a buck. And I do worry my questions revealed distrust and maybe changed how he sees me.
MFL: I’ve heard this before. A patient once told me, “I need honesty, but I’m scared I’ll offend the only person who can help me.” It’s a tough balance. Do you think the hype around mistrust is as big as some claim?
Sam: It’s exaggerated, honestly. Most doctors want to help. The media stories, there’s this thing called Open Payments database which tracks all the money from drug companies paid to doctors—they make everyone look suspicious, even those who are clean. But these doubts are real, especially for people out there like me with chronic illness who don’t necessarily get better with one or two medicines. I just hope my doctor and I can move forward.
MFL: Sam, your honesty will help so many people—patients and doctors alike. That fear of breaking trust is real, but so is the power of deeper, open conversations.
Sam: I mean, I think you’re right. Part of me regrets opening Pandora’s box with these questions. I think it fundamentally changed our relationship. Every time I go to see her, I get the sense that I’m kind of a disappointment to her, or I’m just there wasting her time. But part of me wouldn’t go back and change what I did. In a way, I had to doubt Dr. —— to get the answers and the reassurance I needed that she really wanted to help me.
MFL: And?
Sam: Well, it’s taken some time. But I feel we are making more progress with my migraines than we did in those earlier days. Maybe it’s just a placebo effect or something, I’ve not changed a whole lot of my routine or anything. I’ve had more steady work lately, getting more regular sleep. I’ve learned to manage my stress a bit better. Actually, we did switch from amitryptline to Emgality. And I don’t get migraines nearly as often.
MFL: It sounds like a lot has changed the way you’re putting it. Better sleep, more financial security, coping with your stress, and finding a good medication that fits your needs.
Sam: Yeah… it’s just hard to say because it’s taken so long to get here, and I’ve just thought so much about how it all started with that one conversation at the beginning of the pandemic.
MFL: Well, I’m glad it worked out for you in the end. And we wish you the best with your ongoing journey.
Sam: Thanks for having me. If others listening feel like I did—ask your questions. It might be uncomfortable, but real trust starts with being real.
(To protect the identity of the patient, we have intentionally not provided their last name in this transcript.)