How to Actually Get Heard by Your Doctors (Without Getting Dismissed)
You know what's wild? That we have to strategize just to get basic medical care. That we have to learn a whole new language and master psychological tactics just to be taken seriously when we say something hurts.
I recently sat down with Kayla Thompson-Riviere, a registered nurse and personal medical strategist who runs Heard For Life. She helps people navigate what she calls "the medical merry-go-round"—that exhausting cycle where you see specialist after specialist, get dismissed or told "I don't know," and then start all over again with the next referral.
The conversation was full of practical strategies for communicating with providers in ways that actually get results. And look, it shouldn't be this way. But until the system changes, we need tools to navigate it.
The Communication Gap (And Why It's On Us to Bridge It)
Here's something that Kayla pointed out that honestly made me frustrated and validated at the same time: the burden of effective communication falls squarely on the patient. The person who doesn't have clinical training. The person who's exhausted and in pain and just trying to get help.
It's unfair. Full stop.
But Kayla has found through years of bedside nursing and now working with clients that how we frame information makes all the difference in whether providers actually hear us.
Lead with data, not emotions.
Instead of: "Ever since I got sick, nothing feels right."
Try: "My symptoms began abruptly after a documented (or undocumented) viral infection in March 2022 and have persisted over 18 months, affecting multiple systems—neurological, gastrointestinal, and autonomic."
The first version is true and valid. But the second version gives your provider something concrete to work with. When we use language rooted in patterns, timeframes, and specific systems, providers are more likely to take us seriously.
And here's the thing: this doesn't mean your feelings don't matter. They absolutely do. That's what therapy is for. That's where you get to come in and be as emotional and non-logical as you need to be. But in the doctor's office, they're trying to figure out what's biologically happening in your body. They need to stay in their logic brain to do their job, which means we have to present information in a way that keeps them there.
And yes, I know and agree that this is unfair labor on our end.
Treat Every Appointment Like a Business Meeting
Kayla's advice is to show up with an agenda, notes, and a clear plan for what you're trying to accomplish.
Your three-part prep framework:
List of key diagnoses (or what you're suspecting if you're still looking for answers)
Current symptoms and functional impact (quantified with data)
Your goal for this appointment (what you want to walk away with)
For that second part, here's another example of reframing:
Instead of: "I've been so exhausted lately."
Try: "I'm experiencing unrelenting fatigue that doesn't improve with rest and worsens with physical or mental exertion, similar to post-exertional malaise," Kayla says in our interview.
Notice how the second version weaves in clinical language without sounding like you're diagnosing yourself on Google? That's the sweet spot.
The Breadcrumb Technique (Or: How to Lead Your Doctor to the Answer)
This one was so interesting for me to hear Kayla explain, because it’s something I’ve intuitively thought about before but have never put into words. I love when we find universal experiences between us, because it usually means we’re on to something! Kayla calls it "leading the witness" or the "breadcrumb technique," and it's based on a simple truth: if you want a doctor to do something, you cannot tell them that directly. (For the most part).
The goal is to make them feel like it was their idea.
Here's how it works, using POTS as an example:
Step 1: Start with curiosity, not conclusions "Can we talk through what might cause these symptoms, especially when it only happens after I've been standing for a while?"
Step 2: Narrow it down with data "I've noticed my heart rate jumps 40 beats per minute when I stand, but my blood pressure stays about the same. What could cause that?"
Step 3: Name the category without naming the test "Would this fall under autonomic dysfunction or something similar?"
Step 4: Point to the test as a question "Would a tilt table test help clarify that, or is there another way we could evaluate this?"
Does this feel like we're playing psychological games? Yeah. Should we have to do this? Absolutely not. But until the system changes, this approach has a much higher success rate than walking in and saying "I think I have POTS."
Now, for some more nuance and caveats… When you find the right doctor, you do not have to do this anymore. I can literally show up at my doctor’s office now and say something like, “I’m experiencing XYZ, I think it’s because of XYZ, what do you think?” If they agree, they might already have the solution in mind, or I can ask for the solution I’m thinking about.
When You're Being Dismissed
Dismissal doesn't always sound like "it's all in your head." Sometimes it shows up as "let's wait and see" or "everything looks fine."
Kayla's tactics for pushing back:
Mirror what you're hearing: "Just to clarify, are you saying we're not going to pursue any testing at this time?" (tone: matter of fact and unemotional).
Stay neutral but firm: "I'm concerned this isn't being taken seriously. What would it take for you to investigate further?" OR “Can you help me understand the chain of thoughts leading to your decision?”
Separate overlapping issues: "I agree that anxiety plays a role, but I want to make sure we're not overlooking something new or separate."
Reclaim your space: "I want to make sure we're not missing something important. Can I finish the thought?"
And here's a power move: always ask that your concerns be documented. "Can you please note that I requested X and it was deferred?" This often makes providers second-guess whether declining really is the right call.
The Reality Check: You're Your Own Care Coordinator
Kayla said something that I think we all need to hear, even though it sucks: the person coordinating all of your care, facilitating communication between specialists, and driving toward diagnosis and treatment is you.
It would be amazing to have a magical Dr. House figure who's going to connect all the dots, but that’s just not the reality we live in.
She shared a story about a client who had this random collection of symptoms that didn't make sense. It took 75 minutes of detailed questioning before the client mentioned hearing a thumping in her ears. That one detail shifted the entire perspective and led to diagnosing a rare, aggressive autoimmune condition that really needed to be properly addressed.
But here's the thing: that client never mentioned it to her doctors because when you have less than 15 minutes, you're not talking about your ears. You're talking about the bigger, more obvious problems.
This is why complex conditions slip through the cracks. Not because providers don't care, but because the system doesn't give them time to dig.
Bring Someone With You
Whether it's a friend, family member, or someone with clinical training—bring someone to your appointments.
Being a patient is inherently disempowering. You're literally sitting there in a paper gown while someone with all their degrees on the wall tells you what's happening to your body. When the emotional brain turns on, the logical brain turns off. Having someone else there who's a bit more removed from the situation can help you stay grounded and catch details you might miss.
A Note on Providers
Look, providers are overworked and on the cusp of burnout. When we need extra effort from our care team—which we do when dealing with complex conditions—we're not going to get that buy-in if we're also being antagonistic.
This doesn't mean accepting dismissal or disrespect. It means using collaborative language that keeps your care team working with you instead of against you. Frame requests as partnership: "What would be the next best step? Would a neurologist or autonomic specialist be the next best set of eyes to help move this forward?"
And remember: doctors are a hire-and-fire situation. If they're not willing to engage in respectful dialogue, find someone else.
None of this is fair. The healthcare system isn't broken—it's working exactly as it was designed, just not for patients or providers. Until we get systemic reform, we need strategies to navigate the obstacle course.
Start with one thing from this list. Just one. Maybe it's the way you frame your symptoms, or bringing someone with you to your next appointment, or using the breadcrumb technique for something you've been wanting to explore.
You deserve to be heard. And sometimes that means learning to speak the language that gets you there.
This blog post is based on an interview with Kayla Thompson-Riviere on The Chronic Illness Therapist Podcast. For more resources on navigating healthcare challenges, subscribe to our newsletter and follow us on social media.
Disclaimer: Everything we discuss here is just meant to be general education and information. It's not intended as personal mental health or medical advice. If you have any questions related to your unique circumstances, please contact a licensed therapist or medical professional in your state of residence.
Listen to my full conversation with Kayla Thompson-Riviere on Ep 109: How to Actually Get Heard by Your Doctors (Without Getting Dismissed)
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Episode transcribed with AI and may contain errors that are not representative of the actual word or meaning of the sentence.
Kayla Thompson-Riviere
[00:00:00]
Destiny Davis LPC CRC: The Chronic Illness Therapist Podcast is meant to be a place where people with chronic illnesses can come to feel, heard, seen, and safe. While listening to mental health therapists and other medical professionals talk about the realities of treating difficult conditions, this might be a new concept for you, one in which you [00:02:00] never have to worry about someone inferring that it's all in your head.
We dive deep into the human side of treating complex medical conditions and help you find professionals that leave you feeling hopeful for the future. I hope you love what you learned here, and please consider leaving a review or sharing this podcast with someone you love. This podcast is meant for educational purposes only.
For specific questions related to your unique circumstances, please contact a licensed medical professional in your state of resident.
Kayla Thompson Riviera is a registered nurse and personal medical strategist who helps clients turn medical chaos into a career plan with over a decade of experience in clinical care, hospital systems, and patient advocacy. She now runs Heard For Life, a private practice supporting clients facing [00:03:00] chronic illness, medical mysteries, and system failures.
Kayla specializes in helping people who've been dismissed, misdiagnosed, or left in limbo by the traditional healthcare model. She's known for her sharp clinical instincts and fierce advocacy and ability to connect the dots that others miss. Kayla, I am really looking forward to our conversation today.
The topic of feeling dismissed and unheard. And even when you are heard in the system, you still can often just be left with like, well. I have nothing left for you with a specialist, and then you do it all over again. So why don't we start there? Can you tell me your thoughts about that process and, and tell me Yeah.
More about what you do with clients to help them navigate this.
Kayla: Yeah, absolutely. Um, so I love to call that the medical Merry-go-round. Um, I think probably all of your listeners have been on it. Um, and the key is how you get off. So that is, um, really the goal of my work with clients at Herd for [00:04:00] Life. Um, and today I brought, I brought my notes to figure out how to summarize. What we do and translate it into what your listeners can do to help exit the merry-go-round themselves.
Destiny Davis LPC CRC: Yes, please.
Kayla: So, um, the first thing that I wanna go over is how it's, it's really important and it's, I think, very underestimated, um, how we communicate with our providers. You know, we're lucky to get 15 minutes. with someone listening before, and then through that time they're filtering through what we are saying and trying to figure out what to do with it all. Um, and it's, I just wanna stop and say that it's. Really unfortunate and unfair how much burden of communication is put squarely on the [00:05:00] shoulders of the patient who, you know, for the most part doesn't have clinical training to bridge that communication gap. Um, but that's really, a lot of times that's, that's. What we do when I come in and start working with clients, oftentimes we're not even finding anything new. It's just the way that it's being framed in the light that it's being put under, um, is what moves the needle for people. you always want to, as much as possible, lead with data, um, as opposed to thoughts or feelings.
So let me give some specific examples on this. For instance, um, instead of saying something like, ever since I got sick, nothing feels right. Um, you want to be more clear about what that means and also timeframes and data. So, my symptoms began [00:06:00] abruptly after a documented viral infection in March, 2022, and have persisted over 18 months affecting multiple systems, neurological. Gastrointestinal and autonomic, that is a much more clear story for a provider to be able to work with. And also it makes, again, it's not right that, that it, it is this way, but when you present a case like that, it gets providers to take you more seriously. when we. with language that, um, is rooted in emotion, it often leads to us being dismissed.
Whereas when we can focus on, um, statistical patterns and trends and give them data to work with, they're a lot more likely to listen to us. Um,
Destiny Davis LPC CRC: Yeah.
Kayla: a whole podcast episode about [00:07:00] why that is the way it is. Um.
Destiny Davis LPC CRC: know, I know I wanna add because this is something that used to light a fire under me. But to be honest, the more I've done my own development and emotional work, um, again, still not fair that we like have to do this much work around it, but it also, like the doctors are trying to figure out what is biologically going on in your body?
And when you throw the emotional component and onto it, it's, they can't. Be in their logic brain. And so they are just gonna push that aside to stay in their logic brain and hopefully do their job, which requires you to be in your logic brain. And again, not fair that we have to do all this compartmentalizing and learning a new language.
And, but I would say like as a therapist, right? That is the space where my clients get to come and use their emotional brain. They get to come in and say anything they wanna say in the most emotional and like non-logical way possible. And [00:08:00] we. There's space for that. They're allowed to do that here. And so it would be wonderful if like we could have one person who could do it all, like the emotional, and they know the body and they, but I don't think that's realistic in any system.
So I just wanted to, I guess, put that out there. I don't think I've really said that much on this podcast yet.
Kayla: Yeah. No, that's, that's a a great point. Other side of that though, if I was queen and ran the world, um, I would have more communication technique be involved
Destiny Davis LPC CRC: Yes,
Kayla: medical school. Um, I
Destiny Davis LPC CRC: totally.
Kayla: like across the board, um, physicians are sorely lacking in effective communication skills. So that, that's it. Yeah, if I could wave my magic wand, that would definitely be an area that would be addressed also the impact of nutrition and disease.
But anyways, that's again, another podcast. Um, [00:09:00] absolutely. So I also wanna, I really wanna encourage you guys when you're going into your appointments, um. I always say you should treat every doctor's appointment like a business meeting. You should have an agenda, you should have notes. You should know exactly what you're trying to get when you walk in there.
And also a plan for how you're going to get it. Um, spoil alert. Don't walk in and say the thing that you want. I have a technique for that too. Hold on.
Destiny Davis LPC CRC: Okay. Yes. And this is where I'm like, that's so unfair. Yeah. Even as you were like explaining that clear sentence, I'm like, now they're just gonna call everyone AI cheaters who like are just you. You know what I mean? Like, God, we can't win, but go on.
Kayla: Yeah, and it, it's also one of those things too, right? Where like you can have your best plan, but still you kind of have to read the room, um, and kind of get a feel for that clinician and where they are on, on the spectrum of listening [00:10:00] versus, you know, being very. Standoffish and egotistical and kind of weighing out your approach.
Um, this is why I called myself a medical strategist because there's just so much out the people aspect that. Shouldn't have to be involved, but that absolutely impacts whether we get the outcome we are looking for or not. but at a minimum for preparation, this is take out your pens and notebooks, um, but you want to prepare for a doctor's appointment.
Uh, three key sections. So first being list of key diagnoses or if you're still chasing one, the things that you're suspecting. Um, number two, current symptoms and the functional impact. So again, this is where, um, focusing on the data and the. The impact it [00:11:00] has on your life as opposed to just the feelings.
Um, another example there of, what do I mean by that? Instead of, I've been so exhausted lately. Um, maybe we can quantify that out into I am experiencing unrelenting fatigue that doesn't improve with rest, or is worse with physical or mental exertion, similar to what's described as post exertional ma lace.
So there you hear how I'm weaving in my suspected issue, but not in a way that's saying, Hey, I looked this up on Google and WebMD. 'cause again, that approach is. Is gonna get you written off from the door. And I, I think everybody knows that, um,
Destiny Davis LPC CRC: It also just. I always wondered why it's hard, you know, hard for a doctor to hear what you, you come in with the diagnosis that you've, you've thought of. I just, the psychological part of my brain is like, their brain is [00:12:00] in the prob their, their brain is in the, I don't know yet. And so we've gotta figure this out.
And you've come in saying, no, it's this. And now they just see that as gonna be like, well now you're dead. Set on that. And my job is to be. I guess curious and um, maybe that's a little too much grace there, but like, my job is to like figure this out and you're telling me exactly what it is, but that may or may not fit with what I'm seeing, and so it just causes this automatic divide or this automatic, like it takes them out of, I think their process.
That's just what came up for me.
Kayla: Yeah, that definitely can be a part of it. And I just wanna say from my time at the bedside, um, there, there are definitely, there's so many times where. I've been working with a patient and they would come in and ha be very dead set and that, no, I know what's wrong with me and this is what it is.
But then the clinicians who actually have that working knowledge and background understanding and nuance of how these pieces actually work [00:13:00] together can look at every, all the data we're getting back on this patient. You know, we can clearly see that it's not that thing, and yet that patient. Um, can be very adamant and argumentative and ultimately get in their own way.
And that's an experience I've seen repeated several times. And so unfortunately too, one of the things that you have to realize is when you are going in and you do have some some, you know, research that you've done on the topic, chances are you're, you're the clinician you're working with. had the experience that I've just mentioned, and it is burned in their brain. And so, you know, it's that emotional baggage that you're not seeing from behind the scenes, but that clearly impacts the way the clinicians are showing up. So that's why, you know. Uh, I always, I always try to lead with that, that humbleness. But at the end of the day, I also wanna impress that, you know, the, the provider that you're [00:14:00] seeing it, you know, they may be the expert in that field, but you are the expert in your own body and trust and lean into that.
And I also wanna throw out that. I also subscribe to the ideology that, you know, doctors are a higher fire situation, okay? If, if they're not working for you, if they're, you know, you're maintaining respectful dialogue and they can't be bothered to hear you, or they're not willing to entertain any of your theories, they are not. The provider for you and you know, let's move on and find another one, because respectful dialogue should be met with respectful dialogue, period.
Destiny Davis LPC CRC: I think the biggest pet peeve I have is when they say. Oh, well that shouldn't hurt. Why did, why is it even necessary? Like, cool. It shouldn't, so tell me why it is. Like,
Kayla: Yeah.
Destiny Davis LPC CRC: the one thing where I'm like, uh, yeah. There's no excuse for that. Just there's, [00:15:00] there's none. It does hurt, period. I.
Kayla: Yeah. And interestingly, um, and I imagine you've probably heard this from more of your, um, identifying as female patients, um, but there's a, there's a long history of misogyny baked into medical practice. I mean, even into the textbooks. And you also have to think that. You know, uh, in the past 20, 30 years, like think of all the technological advancements that we've had, at the same time, most of your providers have probably been out of medical school that long or close to it, and their textbooks are that they learned from, or even older than that, so that this is why, you know, we've seen progress over the past several decades, but there's still so much lingering kind of old. I, knowledge isn't even the right word. 'cause to me knowledge means it was correct,
Destiny Davis LPC CRC: Yeah. Yeah. I'm with you.
Kayla: [00:16:00] that they were taught, for instance, one of the things that came up when you mention that just now is for a long time, um, you know, the OB GYN community really was taught and believed that the cervix had no nerve ending. And that was one of the things, oh, you shouldn't be able to feel your cervix. In fact, um, when I was having my first baby and I was starting to have cervical dilation, I, I could feel it and they were like, just, you can't feel cervical dilation. I was like, well that's weird 'cause I am like, you just told me that I am dilated.
So that's clearly why. So all of this to, to, to say is that, you know, the research that we have today in 2025, it's gonna be a long time before it's actually standard practice. In fact, I read somewhere that it takes on average 17 years for something to be identified in the literature for it to become standard practice.
That's a
Destiny Davis LPC CRC: yeah.
Kayla: long time and that impacts. Not [00:17:00] just the, the biases and, um, beliefs that your providers are holding, but also treatment options. You know, at, at this point in time with the way, um, modern medicine is just rapidly developing. You really have to assume that, especially if you have an out of the box condition, meaning not something typical like diabetes, high blood pressure, et cetera. Um, but you have to be prepared to do some of that research and legwork on your own because chances are your providers are working with what's now considered so outdated because just the development is so fast. Um, but I do wanna talk about my breadcrumb or lead the witness technique.
So. as Destiny mentioned at the top of the show, my background is as a registered nurse and I worked bedside even before I had, um, a nursing degree. I don't know. What are we on? 13, 14, something like that. [00:18:00] Many, many years. And one of the things that I have found throughout all of my career is that. If, if you want a doctor to do something, you cannot tell them that.
Has anybody seen the movie Inception? The goal is to make the provider feel like it was their idea through a series of leading questions or statements that kind of walk them there. So I'm going to, I, I wrote down an example to hopefully help make this make more sense. so for instance, let's say that you, you know, have been having this dizziness and lightheadedness reading up on pots and feel like that's a good fit. Well, we've already said don't walk in the room and tell the doctor you think you have pots. So what are we gonna do instead? So step one is start with [00:19:00] curiosity, not conclusions. So for example, can we talk through what might cause these symptoms, whatever they are for you, especially when it only happens after I've been standing for a while.
So you here how we wove in a clue to kind of narrow down their thinking, but we're not dictating that. Step two, we're gonna narrow a little further. For example, I've noticed that my heart rate jumps 40 beats a minute when I stand, but my blood pressure stays about the same. What could cause that? again, we're taking some of those pieces of evidence and framing them in a way that is getting their thinking.
Where ours is. Step three, name the category without naming the test. example, would this fall under autonomic dysfunction or something similar? [00:20:00] This gently introduces a clinical frame, but without it sounding like you're calling yourself a Google md And then step four, now point to the test. But as a question, a tilt table test or something similar help clarify that?
Or is there another way we could evaluate this? Of course this doesn't work all of the time, but I have found the success rate when following this kind of laying out the breadcrumbs technique is much higher than, well anything else that I've attempted. if this still isn't moving the needle though, I do have a couple of other, I'll call them bonus moves for that strategic framing. So sometimes, again, depending on the provider, sometimes I'll appeal to their, their clinical curiosity. So something along the lines of, I know this isn't straightforward, but it's such a consistent pattern.
I'd really value your take on what we, what might be missing.[00:21:00]
Destiny Davis LPC CRC: It is really frustrating.
It is because, you know, it shouldn't, it should not be this way. I, and it's true. I, I found myself doing this without thinking about it. Like I've, you know, and that's obviously where the technique is coming from through, it's through experience, through realizing like, oh wait, when you do it this way, it works.
And I will, I wanna pause and just acknowledge, like, it can almost make us sound more, you know, we're accused of being manipulative and this is. It, it, it's making it sound like if you're thinking about it and trying to figure out how to, but we have no choice. This is the only way to get answers to what we're looking for without it being, well, I just don't know.
So come back, like, come on, it's, we need more than that and if you don't want us to do this, then you've gotta do better. Like,
Kayla: I know it, it, it's, it's wild. I mean, I think about it all the time. I'm like, my, like my whole business should not need to exist. Like this is,
Destiny Davis LPC CRC: okay.
Kayla: this is [00:22:00] insanity, but
Destiny Davis LPC CRC: Yeah.
Kayla: until we remove, um. You know, these insurance companies that dictate the way Reimbursal goes and which then dictates the way everything runs until we get around that I don't, I don't know a better approach because at the end of the day,
Destiny Davis LPC CRC: Yeah.
Kayla: very limited amount of time, um, in the room with that provider that's gonna set up the next three months maybe of what our clinical
Destiny Davis LPC CRC: Yeah.
Kayla: And so. my whole approach is like the system is, I mean, it is screwed up. I, I used to say that it was broken, but broken implies that something is functioning in a way it wasn't designed, and I don't think that's what's happening here. This is by design. The healthcare system is working exactly as designed.
It just wasn't designed for patients or providers.
Destiny Davis LPC CRC: [00:23:00] Yeah, yeah, yeah. I was, I was gonna liken it almost to therapy. Like, therapy shouldn't need to exist because trauma shouldn't be a thing. But I do. I think there's a certain amount of trauma that's, you know, in nature in the way life just is, and that's just inevitable. But this doesn't have to be inevitable like this.
Kayla: Yeah. Agreed. Agreed. Um, and you know, there's people working on healthcare reform and you know, all the best to them 'cause we desperately need it. Um, that is not the gift I was given. So I work with people through Okay. You know, healthcare is an obstacle course. Um, you know, essentially we can, we can sit here and validate that that is, you know, wrong and it shouldn't be that way. But at the end of the day. We can't just wait for somebody to fix it. So let's strategize how to move through that obstacle course. That's really, uh, my,
Destiny Davis LPC CRC: Yeah,
Kayla: on it. Um, but going, going back to some of those kind of bonus [00:24:00] phrases, if this, um, leading the witness or breadcrumb strategy still hasn't moved the needle for you. I talked about appealing to their clinical curiosity. Um, another, another tactic that can work is asking for a second opinion, but like everything else we've discussed, the way you ask impacts that outcome. A way to do it without implying that that provider has failed. 'cause we don't wanna touch that ego button to, um, ask for a referral, um, in a way that it frames it as. What would be the next best step for, for instance, would a neurologist or autonomic specialist be the next best set of eyes just to help move the process forward? So this, again, we're, it's, we're aiming at the same outcome, but this is a addressing it, framing it in a way that's very collaborative as opposed to, [00:25:00] well, since you don't know what's going on, um, and that really is the underlying.
Theme to what I impress upon all of my clients is, you know, we always, always wanna be using language that is keeping this care team working together and staying away from an us versus them dynamic, which is way easier said than done, especially when these, um, you know, these chronic health conditions impact all aspects of your life.
It is so easy for that to become a very emotionally charged. Situation, but just like destiny, just like you were saying at the top of the show, when your emotion is pulled in and then the doc's emotion is pulled in and you're not getting what you need and you feel like crap is very quickly spirals into an us versus them dynamic.
And let, let [00:26:00] me tell you. Your clinicians across the board are overworked and on the cusp of burnout. Okay? They get somebody just very emotional on them. You know what happens? They go, I don't have time for this. And they, they don't like we, you have a condition, again, that's not something clear cut.
And in the range of typical in healthcare. going to require extra e effort and emphasis from all of your clinical team to get you through that health journey to the point of, you know, appropriate treatment, recovery, whatever it is for you. And when we need that extra buy-in from our care team above what is typically required of them, we simply aren't going to get that if we are also being antagonistic in our approach. Um, which once again, it's a shame because like [00:27:00] are, these are the times where it is the most emotional. I always recommend. Having someone else go with you to these appointments. Ideally, somebody who has, you know, clinical training in something, you know, someone like myself, but if nothing else, I mean, bring your mom, your neighbor, your best friend, just somebody, because just inherently being a patient. Is a disempowering position. I mean, you walk into the office or the hospital and you know how many times, how many times have you gone to a doctor's office and they have like all of their degrees on the wall, then they're like, okay, here, take off clothes and put this paper over you. Like that's a very, very disempowering position.
Destiny Davis LPC CRC: Yep.
Kayla: then as. Soon as the conversation starts to steer even a little off course, I mean, it can just ve go down that spiral very [00:28:00] quickly.
Destiny Davis LPC CRC: Yeah, I think we can. Stay there a little bit longer, like yes, that my therapist trauma brain is going to like, yes, you are naked on a table with a very thin cloth around you, napkin paper around you. Uh, and yeah, that alone is vulnerable. If you're angry, you can't just get up and walk out. If you see like, you know, it's so true, like, so true.
You are in a vulnerable position. And some of us can handle that in a way that's like. We don't feel so vulnerable. Like I know, I'm just, I'm a little bit like more assertive, more like if someone's being rude to me. Like I don't really care that there's a piece of paper on me, like I'm gonna tell you to get out.
I'm, in fact, that happened while I was in the, OR getting a C-section. So, um. Yes, the doctor came. They, they, so, uh, a little story time in the middle of this, but um, it trigger content warning for anybody who has had medical trauma. I will be talking about this, [00:29:00] so feel free to skip through a couple minutes.
But, um, yeah, I was transferred from a birth center to the OR and um, I was pushing, I could not stop pushing every minute. It was automatic. And, um, I. But I had no medicine in me, and so, and I couldn't, and she wasn't coming out. And so anyway, they, they threatened to get this male doctor to come in to get me to stay still so that they could put the spinal tap in and like, how do you think threat?
Like how do you, what are you gonna hold me down? The whole thing is that I can't sit up right now and I can't stop moving like that. And so anyway, he comes in and he tells me, what kind of example are you setting for your unborn child? And I just, I went.
Kayla: it.
Destiny Davis LPC CRC: Of course my husband wasn't in the room because this was like, or like, he couldn't come in yet and like, so, um, he stayed in the, in the whole like after the spinal tap was in me.
And I was obviously on cloud nine after [00:30:00] that. But, um, he stayed in the room and he was just talking to the, to labor and delivery nurse about his. Fucking workday. Like I just, just talking about his day and he said something, I don't remember exactly what, what it was now, but he said something around, he said something like he couldn't.
I don't know. It was something about his attitude and how he couldn't like, have a conversation with somebody. And I was like, well, I guess you're just gonna have to get, get over. Like, I used whatever his words were to me at him, and everybody in the room just laughed. And that's just me though. Like, you're not gonna, you're, you're not going to, I'm just not scared like that.
Which maybe that is actually could get me into some trouble. But, but I, that was just a, a story time for everyone. It was. This stuff is, it's so insidious sometimes and so ingrained, and they think nothing of it, and I get it. It is because this is their job. They come in, they do this every day. They have to disconnect.
Disconnect from the [00:31:00] people in front of them. And our emotional responses is not going to get them to connect. It's going to make them push them farther away. So anyway, I digress. Please feel free.
Kayla: Ugh, this is gross.
Destiny Davis LPC CRC: You know what? The fact that I was able to, and this is in trauma research, we know that when somebody is able to, whether they, because it's something in your control or maybe sometimes not, it's just luck sometimes when you are able to fight back. When you're in a traumatic situation, uh, when you're able to run out of a building that's burning, when you're able to do something that helps others or get someone else out of the situation, you have a less likelihood of developing PTSD.
There's something about that sense of empowerment that like gets you out of that and. So I think that that, like, I did not walk away feeling traumatized from that. I walked away feeling like, yeah, fuck him and whatever. Like, I like, um, you [00:32:00] know, and so I think, and so sometimes that's just luck of the draw, whether you get to, to do something empowering or not.
It's not, it's not as simple as a choice, but just important to note, I think.
Kayla: Yeah. Although I do think that, you know, having some of this framework in mind helps then when you go into those kinds of situations, um, it's so interesting. You, you bring that up and you share your story because my. Me starting this business, um, entrepreneurship was not on my Bingo card. Okay. This was not, was not a plan.
Um, I actually, I, so I function under the industry of independent patient advocacy. Um, I just rebranded 'cause people have challenges with that phrase. But anyways, I digress. Um, but I had first heard about independent patient advocacy and I was like, wow, that's so cool. I was like, oh my gosh, you mean I can do just that? I was like, I've been fighting for what my patients [00:33:00] need in between, like managing their life support. I would love to do just that. Um, but it is a relatively new kind of thing. So if it's something you wanna do, you also have to start a business and do it yourself. And I was like, what? I don't know about that. Um, and then I actually a couple months later found myself in my own, um, very challenging health experience and I was. was very humbled very quickly, and I found out firsthand that even though I have the knowledge and I have, I have no problem going toe to toe with providers on my patient's behalf. You know when, when you are the person that it's happening to or it's your loved one. Completely different. And you know, I'm sure you can speak to this destiny, but when the emotional brain is turned on, the logical brain [00:34:00] is turned off. And it was, it was very profound for me how, how difficult it was to both be going through the experience be fighting for my care. Um, because it was, it was a whole series of things that never should have happened, and I, I had to fight for myself every step of the way. And it was actually on the heels of that experience that, um, once I recovered, I told my husband, I said, I have no idea what this is going to take, but I'm gonna figure it out because nobody should have to fight on their own the way that I did. So I can can relate.
Destiny Davis LPC CRC: Yes. Yeah. Yeah, I know. That's where a lot of this our work does stem from. It's just, you know, the personal drive to, to do this, this work. Yeah.
Kayla: So I just wanna throw that out there though,
Destiny Davis LPC CRC: Yeah.
Kayla: who's listening and they're like, oh, it sounds good, but I have [00:35:00] such a hard time with this. Well, of course you do. 'cause
Destiny Davis LPC CRC: Yeah.
Kayla: and
Destiny Davis LPC CRC: Yep.
Kayla: nothing wrong with you, it's your. Your own survival needs are, are being tied in and it makes it that much more difficult. So all of that to
Destiny Davis LPC CRC: That's
Kayla: and
Destiny Davis LPC CRC: why that helpful.
Kayla: bring somebody else with you.
Destiny Davis LPC CRC: Yep. That's what I was just gonna say. Exactly. Yeah. Even if you are pretty assertive or whatever, like it does help to have somebody else in the room. Yeah.
Kayla: Yeah. And in the event that you know, things. You know, sometimes things don't go the way we want or we get test results back that we were hoping it, that wasn't what they were saying. Um, oftentimes if there's big news or bad news, it can be hard to actually remember everything that they say. And so having another person who's obviously a little bit more removed from the situation than you are, um, can be helpful shely as that second set of ears, if
Destiny Davis LPC CRC: Yeah.
Kayla: else. Um, so [00:36:00] I also wanted to address some of this, um, bias and dismissal and some techniques around that. So, as you've already mentioned, destiny, um, dismissal is not always overt. Um, sometimes it shows up as simple as, oh, well let's wait and see. Or everything looks fine and it's often driven by unconscious bias about gender, race, weight, or even difficult notes in your chart from
Destiny Davis LPC CRC: Yep.
Kayla: providers. but I have some tactics for that. So if you feel that you are being dismissed, told everything is fine, or let's just wait and see, here's a few strategies. Number one, you can mirror back what you're hearing. So for instance, just to clarify, are you saying we're not going to pursue any testing at this time? [00:37:00] Sometimes a simple reframe them to say, oh, you know what? Maybe that's not the most appropriate course of action. Oftentimes do nothing is a default response. And just a little bit of a challenge can change that. Uh, number two, neutral but firm. For example, I'm concerned this isn't being taken seriously. What would it take for you to investigate further? this opens a door for more details that perhaps weren't woven into the conversation earlier, and can again change that outcome. Number three, if everything is being attribute attributed to one factor, such as past trauma, mental health, or a known diagnosis. You can say something along the lines of, I agree that anxiety plays a role, but I wanna make sure we're not overlooking something new or separate. Um, [00:38:00] number four, if you're being interrupted or redirected, you can say something along the lines of, I want to make sure we're not missing something important.
Can I finish the thought? So, always ask that your concerns and requests be documented in the chart. if they're declined with something along the lines of, can you please note that I requested X, Y, Z and it was deferred? Um, this puts that, um, a little bit more of the burden back on them and oftentimes we'll flag them to second guess if that's actually the right move.
Or maybe, maybe
Destiny Davis LPC CRC: Yeah,
Kayla: ahead and order it.
Destiny Davis LPC CRC: I read a comment one time, so don't know this person at all, that they did that technique and that the doctor said they weren't gonna see them anymore. I'm wondering though, do you think that that likely meant that, that that patient had a history of being combative, or do you think it would be as simple as asking that question, [00:39:00] could get you fired as a patient?
Kayla: Yeah, I mean, it's hard to say without the context of
Destiny Davis LPC CRC: Right.
Kayla: Um, all my initial knee jerk response is if you stay calm, cool, and collected with respectful dialogue and being respectful to that provider's, um, you know, uh, um, knowledge on the subject and they fire you for that.
Destiny Davis LPC CRC: Yeah.
Kayla: You probably needed a new provider anyways because that's somebody who clearly was not, you know, interested in helping you.
And I, I realized that that then creates more headache and hassle. Um, but we're not in the game of easy here, are we? We've kind of that, um, one of the last things I wanna make sure I point out is that. On the topic [00:40:00] of looking for providers, um, I hear a lot of times that people, people are hoping to find that one doctor who is gonna put it all together and figure it out and you know it, it's not, it's a nice hope you can put it, put it on the vision board.
I do believe in manifestation and. It's a good goal, but realistically, probably not going to find that one provider who's going to look at everything and put it all together. Dr. House was a TV show. I, I wish, but again, the, like, the number one thing that I think most of the time it comes down to, aside from the obvious pieces of, you know, expertise and training, whatnot, is time. You know,
Destiny Davis LPC CRC: Yeah.
Kayla: have complex medical conditions, especially ones that cross over [00:41:00] multiple different areas of the body, it's a lot to unpack. For instance, I, I had a client, um, a few months back who she just, she was having this random collection of symptoms, and I'll be honest, when she called me looking for help, I was listening and I'm like, in my head I'm like. Man, I don't, I have no idea what is wrong with her. And I was, I was scared. I was like, I don't know if I'm gonna be able to help her. And I actually, I was very upfront with her about that. I was like, ma'am, I just want you to know, I, off the top of my head, I, I don't, I don't know what's going on with you. Um, but if you think that some help is better than no help, I am happy to help. And the way that I work with clients is I actually start with an initial session that is 90 minutes long and this lady was going through all of her symptoms and. I ask a lot of questions and we dig really deep. It's a lot of why, [00:42:00] why, why, and it was somewhere around probably minute number 75 where she finally, she said this one thing.
Um, she said that she, she felt like she was hearing a thumping in her ears, and I was a thumping. I said, do you, do you think it's your heartbeat? And she thought about it for a minute and she said, yeah, it is my heartbeat. You know, that was actually the one piece of data that helped to shift our entire perspective on that case, which ultimately opened a few more doors and led to her getting this very rare and
Destiny Davis LPC CRC: Oh
Kayla: aggressive autoimmune condition that the rheumatologist said would've killed her if we it had gone on undetected for much longer.
Destiny Davis LPC CRC: Yeah. Yeah.
Kayla: she went to any of her doctor's appointments and told them about this? Sounded no, because when you have 15 minutes [00:43:00] with a doctor, you're not talking to them about your ears, you're talking to them about all the other, you know, bigger problems. That are coming up, but it was that taking the, the time to pause and dig through everything is what made the difference for her and for so many of my clients.
So the fact is, you're probably not get that from one provider within the
Destiny Davis LPC CRC: Yeah,
Kayla: system. And in
Destiny Davis LPC CRC: that makes me think of like, before managed care, before insurance was a thing. Um, not that I ever tried anymore. I, I've gotten out of this trying to glamorize the past, but, um, there were family doctors, you know, one doctor for the whole village and, um, which also meant that when they didn't know about something, they just didn't know and there wasn't anybody else to help with that.
However. They knew everything about your life and they were a part of your com. Like it was easier for them to [00:44:00] be intuitive with you, I think, because they knew you. And so having a 90 minute conversation with somebody, you are going to open up and learn things. You're never gonna get even in 10, in nine, 10 minute appointments.
Kayla: right. And, and you're right. And I hear, I hear about that often and, and it's. know, sometimes I wonder, I wonder what it was like for curiosity's sake. I mean, this is a video podcast. I clearly was not alive in the, the grand old era of primary care. Um, but you know, it's coin always has two sides.
Right? And you, you already started to allude to it. I, I don't wish for those times back because there are so many conditions that. Even if, even if that village doctor knew about that we didn't have treatments for like we do today, and that really is what's driving this specialization of care. There are so many things that. if you could get a [00:45:00] diagnosis where, I mean, think, think of aids, you know, HIV and AIDS in the seventies and eighties, and how terrifying that was. It was a death sentence and now you can take oral medication and be undetectable for life. Like that's amazing. that level of. Of, you know, technology and advancement has required people to get very, very specialized in these niche things.
And so now what has happened is that healthcare has become this myriad of silos and specializations with these providers who go really, really deep in their narrow field, which is great. And also the Achilles heel of their care. Um, if somebody has a condition like that client I just mentioned that crosses over multiple body systems because the provider, for instance, that client had been, was having blood pressure issues were, were part of her [00:46:00] challenge.
And so she was sent to a cardiologist, a heart doctor who did some basic heart testing. Of course, all of it came back negative and they were like, well, I dunno, why don't you go try this one? And that is how we get the medical merry-go-round.
Destiny Davis LPC CRC: Exactly. Yep. Yes.
Kayla: So I wanna impress upon people that while. It would be wonderful to be able to, you know, go see that Dr. House who's gonna be able to crack your puzzle, um, and have, or have that village doctor who knows everything about you. The reality here in 2025. Is that the individual who is coordinating all of your care and facilitating communication amongst all of your providers and driving the train in getting a di appropriate diagnosis and treatment is actually you.
Destiny Davis LPC CRC: Yeah.
Kayla: How
Destiny Davis LPC CRC: Yeah,
Kayla: that?
Destiny Davis LPC CRC: I know, I know, I know. Which is [00:47:00] why we need to be organized and not only the systems that you, you you're talking about here, do you have like paper organiza organization systems that you kind of share with each client that works with you? Or how do you help people organize their medical documents, medical journey, like, or is that, is that something a part of what you do?
Kayla: Um, that, that's a big part of what I do. So, yeah, so I, I start with my clients with that initial deep dive session I was mentioning, and then I actually, I take all of the notes and I compile it down into a strategy document. So what that looks like is it starts with, um, a nice snapshot, like a one to two paragraph synopsis of the ongoing situation In clinical terms, this is actually very similar to what your providers look for in what's called an HPI or a history of present illness. So that right off the bat is really useful, um, for my clients as [00:48:00] they move through future appointments. They get a very nice, concise, no fluff, all the highlights for every provider to get them up to speed within one minute of that first appointment. Um. Now, depending on their health situation, sometimes we'll dive into creating an actual medical timeline too. My approach varies a little bit, depending on truly what that client needs. Um, but following that snapshot I just mentioned. I actually create a step-by-step action plan of, you know, here's kind of the high level areas that we're targeting and the next immediate three to four steps that, that we need to take so that it becomes very clear, um, what my clients need to do instead of this big, overwhelming. well I've got this, you know, handful of prescriptions and referrals, [00:49:00] but no plan, and I have no idea what anybody is thinking.
Destiny Davis LPC CRC: Yep.
Kayla: So
Destiny Davis LPC CRC: Yep.
Kayla: it all and puts it out into to logical, step by step. Um, and then we keep working together. And that cadence again. it varies from person to person, how much support they're looking for. Um, some people throw up their hands and say like, I'm too sick, I'm too tired, I'm too overwhelmed. Uh, I want you to manage it all. Some
Destiny Davis LPC CRC: Yeah.
Kayla: happy for just that kind of essentially coaching, and we just check in once a month and then they manage everything else themselves. Um,
Destiny Davis LPC CRC: Yeah.
Kayla: it really serves to take away that overwhelm and confusion and also bridge that gap by having a clinical partner on your team now who does take the time to know everything about you, but also with a medical, clinical background to, to figure out how these [00:50:00] things kind of make sense for you.
So if this is content that is helpful to you guys, um, I actually have a podcast as well called Scripts and Referrals. Um, because even as I was putting this, believe it or not, this is the paired down version and I still was thinking this is gonna be a long podcast. There's
Destiny Davis LPC CRC: Yeah.
Kayla: much, there's so much to cover. so we'll dive into more depth over on, on my podcast, but here, here were the highlights to help hopefully help start, get things moving for you.
Destiny Davis LPC CRC: Totally. I think it's important to have these in, in small doses and, you know, little bit by bit, get comfortable with what we've said here. Go to your podcast, start, you know, binging those. And, but, but at the same time, like be gentle and kind with yourself when you like, be, um, allow yourself to just absorb one episode at a time, you know?
A, yeah.
Kayla: and, and then when you are. In [00:51:00] the place where you're like, okay, you know, I, I need to apply some of this. Just start with one thing. The, the thing that sticks out to you the most of, oh man, I need that. Start there and then add in the other layers. Um, I
Destiny Davis LPC CRC: Yeah.
Kayla: have a doctor's appointment prep guide that might serve as a really good starting point, um,
Destiny Davis LPC CRC: Great.
Kayla: find at heardforlife.com slash guide.
That is free.
Destiny Davis LPC CRC: Awesome. Good. Well thank you so much, Kayla. What, um, so yeah, and where I'm trying to think if there's any other question I haven't asked. No. You've got your podcast, you got your website, you got a free resource, like Yeah. Thank you so much.
Kayla: Absolutely happy to be here. Thank you so much for having me.
Thanks for listening. If you learned something new today, consider writing it down in your phone notes or journal and make that new neural pathway light up. Better yet, I'd love to hear from you. Send me a DM on Instagram, email me or leave a voice memo for us to play on the next show. The way you summarize your takeaways can be the perfect little soundbite that someone else might need.
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Listen to Dr. Kayla’s interview with me, Destiny Davis, on Ep 109: How to Actually Get Heard by Your Doctors (Without Getting Dismissed)
Kayla Thompson-Riviere is a Registered Nurse and Personal Medical Strategist who helps clients turn medical chaos into a clear plan. With over a decade of experience in clinical care, hospital systems, and patient advocacy, she now runs HEARD for Life, a private practice supporting clients facing chronic illness, medical mysteries, and system failures. Kayla specializes in helping people who’ve been dismissed, misdiagnosed, or left in limbo by the traditional healthcare model. She’s known for her sharp clinical instincts, fierce advocacy, and ability to connect the dots others miss.
Meet Destiny - The host of The Chronic Illness Therapist Podcast and a licensed mental health therapist in the states of Georgia and Florida. Destiny offers traditional 50-minute therapy sessions as well as therapy intensives and monthly online workshops for the chronic illness community.
Destiny Davis, LPC CRC, is solely responsible for the content of this article. The views expressed herein may or may not necessarily reflect the opinions of Sarah Stasica.