# Doctor misdiagnosed my cough for 5 months - it was the Lisinopril. How to confront him? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [January 26, 2012, 5:17pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748 "2012-01-26T17:17:34Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [January 26, 2012, 9:40pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/21 "2012-01-26T21:40:23Z")
> [@drewtwo99](#): > > I would talk to your doctor about your experience in Urgent Care, the research you have done, and to tell him you have stopped taking the prescription. Ask him if there are any extenuating circumstances for why he didn’t talk to you about this evidently common and persistant side-effect, or ask you to get off of the medication himself. No need to be rude about it, and don’t make it seem like you’re scolding him or putting a “gotcha” moment on him. He’s a professional, one who obviously made a mistake, and should be treated with respect, just like how you would like to be treated if you made a mistake when trying to help someone for months (which he was doing for you). If you really feel he is incompetent, then find another physician and tell him why. That’s pretty much all you have to do. This is probably the most common sense way to apprach this. approach it as a follow up to your urgent care visit. “I ended up in urgent care for that cough and the doctor thought it might be a side effect of the medication, so I want to go off the medication…” ---
**Author:** ![Q.N.Jones](https://avatars.discourse-cdn.com/v4/letter/q/3da27b/32.png) [@Q.N.Jones](https://boards.straightdope.com/u/Q.N.Jones)\ **Post date:** [January 26, 2012, 9:47pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/22 "2012-01-26T21:47:45Z")
Your doctor is incompetent. Find a new one. (When I took Lisinopril, every doctor I saw–heck, even my DENTIST!–asked me at every single visit whether I had any problems with a cough from it. Without being prompted. It’s a basic issue that any doctor who prescribes Lisinopril should be aware of.) ---
**Author:** ![smaje1](https://avatars.discourse-cdn.com/v4/letter/s/e47774/32.png) [@smaje1](https://boards.straightdope.com/u/smaje1)\ **Post date:** [January 26, 2012, 10:13pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/23 "2012-01-26T22:13:03Z")
Update: I spoke with my doctor and informed him that another health care professional brought the Lisinopril/coughing connection to my attention. I told him I planned to discontinue the Lisinopril immediately. He told me that was fine, to go ahead and stop taking it – for a while. But he wanted me to come back in a few weeks, and if the cough has disappeared, he wanted me to start taking the Lisinopril AGAIN to be certain that the drug was actually causing the cough. :rolleyes: I told him that I wouldn’t be returning. He didn’t say anything to that, just told me to call if there were any other problems, and asked me if I needed another refill on my cough syrup. I’m not certain he understood what I meant when I said I wouldn’t be returning. Either way, I’m afraid he’s just not on top of his game as a medical professional. And so, I’m off to find a new doctor. ---
**Author:** ![Jackmannii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackmannii/32/311_2.png) [@Jackmannii](https://boards.straightdope.com/u/Jackmannii)\ **Post date:** [January 26, 2012, 11:03pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/24 "2012-01-26T23:03:14Z")
> [@smaje1](#): > > Update: I spoke with my doctor and informed him that another health care professional brought the Lisinopril/coughing connection to my attention. I told him I planned to discontinue the Lisinopril immediately. He told me that was fine, to go ahead and stop taking it – for a while. But he wanted me to come back in a few weeks, and if the cough has disappeared, he wanted me to start taking the Lisinopril AGAIN to be certain that the drug was actually causing the cough. :rolleyes: O.K., that’s dumb of your doctor and good confirmation of the wisdom of finding another physician. It’s hard to see how treating “slightly elevated blood pressure” requires putting you through another round with this drug, when there are alternatives. Be wary of anyone who wants to put you on a _different_ ACE inhibitor, as you would be at risk of chronic cough with another drug in that class. Back in med school we had a cardiac patient on the internal medicine rotation whose hospital admission workup I did. He had a previous history of chronic cough thought to be caused by an ACE inhibitor. Recently he’d developed a similar cough. I checked his med list and sure enough, a short time before his admission he’d been put on another ACE inhibitor. When that was stopped, the cough magically went away. ---
**Author:** ![PunditLisa](https://avatars.discourse-cdn.com/v4/letter/p/4af34b/32.png) [@PunditLisa](https://boards.straightdope.com/u/PunditLisa)\ **Post date:** [January 26, 2012, 11:12pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/25 "2012-01-26T23:12:06Z")
…And do check back in after a few weeks and let us know if the cough has diminished. ---
**Author:** ![Xema](https://avatars.discourse-cdn.com/v4/letter/x/9de053/32.png) [@Xema](https://boards.straightdope.com/u/Xema)\ **Post date:** [January 26, 2012, 11:15pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/26 "2012-01-26T23:15:03Z")
> [@Kimmy\_Gibbler](#): > > You complained of a variety of symptoms and he attempted different treatments. The law does not require the impossible—immediate and unfalliable diagnosis—when the practice of medicine still requires more than a few judgment calls and episodes trial-and-error. This is a strange comment in view of the fact that the doctor didn’t really try different treatments, and, far from an immediate diagnosis, failed to make the connection with a drug’s common side effect for months on end. ---
**Author:** ![MysteryFellow63427](https://avatars.discourse-cdn.com/v4/letter/m/a88e4f/32.png) [@MysteryFellow63427](https://boards.straightdope.com/u/MysteryFellow63427)\ **Post date:** [January 26, 2012, 11:30pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/27 "2012-01-26T23:30:31Z")
> [@smaje1](#): > > But he wanted me to come back in a few weeks, and if the cough has disappeared, he wanted me to start taking the Lisinopril AGAIN to be certain that the drug was actually causing the cough. :rolleyes: Wow, what an idiot! Sorry about your experience and glad you’re off to find a new doctor. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [January 26, 2012, 11:31pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/28 "2012-01-26T23:31:36Z")
> [@enipla](#): > > I had the same problem with that med. But my doc not only clued me in about that side affect, he reminded me and asked when I went back for a re-check on the BP. Sure enough, a dry hacking cough. Weird side effect. I was warned about this when I tried lisinopril 2+ years ago (saga below). It sounds like **smaje1** ’s doctor wasn’t out of line at first in suspecting sinus issues etc. - as the snotty nose is NOT typical of the side effect. But when the cough continued, especially since (I assume) the other sinus-ish symptoms went away, there’s where the screwup happened. Yeah, the OP should have looked up the side effects - this is shockingly common. But this is such a common class of medications that the doctor should have KNOWN about it. Idiot. My tale: I was started on Lisinopril about 2 years ago. Doc warned me that dry cough was a possible side effect, and that if it was intolerable, to come in and we’d tweak it. Well, within a week, nighttime-only coughing started. It got worse and became intolerable (I was already severely sleep-deprived for other reasons). I went back. Doc listened to me, noted that the timing of the cough (nighttime / lying down ONLY) was behaving more like reflux (something I already had), and pursued that. I tried everything she suggested including a LARGE dose of Prilosec, though I drew the line at trying Zegerid - basically Prilosec with a little baking soda, and many times the price of the Prilosec itself. Even did some tests like gastric emptying, and scheduled a visit with a gastroenterologist. Nothing helped. During that time, I stopped and restarted the lisinopril several times and sometimes it seemed to get better when off, and sometimes not. If I had a “bad” evening food-wise I was guaranteed to have a bad night, cough-wise, but the opposite was not true (like the time I had nothing to eat for 5+ hours before bedtime). Finally I put my foot down. Doc put me on an ARB (Angiotensin Receptor Blocker) instead (ARBs can also have coughing but it’s less common). The coughing stopped. I’m actually still pissed at the doctor putting me through all the misery when the coughing - even if it was at nighttime when lying down - was time-wise OBVIOUSLY tied to the lisinopril (reading since then, reflux may also be a side effect of the stuff so I suspect that what happened is it worsened a pre-existing tendency). Now, I did keep the appointment with the gastro, which was a good thing: because of my history of GERD he wanted to check for Barrett’s (endoscopy), and I’m also at an age where a colonoscopy was appropriate… the endoscopy was fine but the colonoscopy turned up something a little precancerous :eek:. Your doctor’s insistence on you going back on the lisinopril is a bit daft under the circumstances, and frankly I do NOT blame you for switching. ---
**Author:** ![Kimmy\_Gibbler](https://avatars.discourse-cdn.com/v4/letter/k/bbe5ce/32.png) [@Kimmy\_Gibbler](https://boards.straightdope.com/u/Kimmy_Gibbler)\ **Post date:** [January 26, 2012, 11:32pm UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/29 "2012-01-26T23:32:07Z")
> [@Xema](#): > > This is a strange comment in view of the fact that the doctor didn’t really try different treatments, and, far from an immediate diagnosis, failed to make the connection with a drug’s common side effect for months on end. Perhaps you should read the OP again. At the first visit, antibiotics were prescribed. At the second, this was supplemented with a cough suppressant. At the third, Vick’s and steam therapy were also recommended. Seems like a variety of treatment modalities to me. Do you care to explain why you insist these are not really different treatment approaches? ---
**Author:** ![Xema](https://avatars.discourse-cdn.com/v4/letter/x/9de053/32.png) [@Xema](https://boards.straightdope.com/u/Xema)\ **Post date:** [January 27, 2012, 12:59am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/30 "2012-01-27T00:59:55Z")
> [@Kimmy\_Gibbler](#): > > Seems like a variety of treatment modalities to me. I concede that these were different attempts at treating the cough symptoms. But there was no attention paid to the Lisinopril, which was unchanged throughout. Do you care to explain how a 5-month failure to take note of a drug’s common side effect can properly be characterized as a failure to make an “immediate and unfalliable diagnosis” ? ---
**Author:** ![Musicat](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/musicat/32/20189_2.png) [@Musicat](https://boards.straightdope.com/u/Musicat)\ **Post date:** [January 27, 2012, 1:08am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/31 "2012-01-27T01:08:32Z")
> [@smaje1](#): > > You misread my OP, Musicat. The cough will NOW take three months to go away now that I’ve discontinued the drug. I am still coughing. And not sleep. And pissing myself with every hack. Then you just made my point stronger. You are assuming it will go away, but it hasn’t yet. If it doesn’t, will you discard your hypothesis? Regardless, although the evidence points to the connection, it is far from proved. Your doctor deserves a modicum of doubt. But toss him anyway. 🙂 ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [January 27, 2012, 1:15am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/32 "2012-01-27T01:15:24Z")
> [@Kimmy\_Gibbler](#): > > Perhaps you should read the OP again. At the first visit, antibiotics were prescribed. At the second, this was supplemented with a cough suppressant. At the third, Vick’s and steam therapy were also recommended. > > Seems like a variety of treatment modalities to me. Do you care to explain why you insist these are not really different treatment approaches? As soon as you explain how someone who is stating repeatedly that he’s not going to sue must be claiming medical malpractice. ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [January 27, 2012, 1:54am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/33 "2012-01-27T01:54:58Z")
> [@Musicat](#): > > Then you just made my point stronger. You are assuming it will go away, but it hasn’t yet. If it doesn’t, will you discard your hypothesis? > > Regardless, although the evidence points to the connection, it is far from proved. Your doctor deserves a modicum of doubt. > > But toss him anyway. 🙂 And I say that that modicum of doubt is not large enough to continue putting your life into the doctor’s hands. Look at the evidence: Doctor is prescribing management strategies to deal with the cough. Doctor never once brings up the side effects of the medication when the person might be having one. Doctor seems surprised that the medicine might be causing the problem. Doctor is so incredulous that he offers to put him back on the medication. Doctor acts clueless when patient tells him he isn’t coming back, as if the concept of screwing something up this badly is beyond them. And let’s not even factor in that he never once explains why he didn’t think it could possibly be a drug side effect. That’s a lot of evidence that the doctor is not good, even if it turns out that the Lisopril is not causing the cough. With many, many more options out there, why risk a doctor with so many signs of cluelessness? I mean, a modicum of doubt is less than is necessary to keep someone out of jail. ---
**Author:** ![thelabdude](https://avatars.discourse-cdn.com/v4/letter/t/dc4da7/32.png) [@thelabdude](https://boards.straightdope.com/u/thelabdude)\ **Post date:** [January 27, 2012, 2:24am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/34 "2012-01-27T02:24:26Z")
The doctor has an out that you were given litature with the Lisinipril listing possible side effects. Likely you threw it away without reading it like everybody else. If you still have the thing, check it. If it is missing a warning about the cough, you may have a case against the drug maker. I am stewing about the doctor that in the year and a half before advanced cancer intrupted my out of town vacation failed to check me for cancer. After I get back, she refused to go ahead with any treatment besides a boondoggle major surgery that might leave me worst off than dead. After 4 months of stewing, I found a real doctor that plans to keep the cancer at bay with a number of minor outpatient procedures leaving me my old self. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [January 27, 2012, 4:27am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/35 "2012-01-27T04:27:49Z")
> [@smaje1](#): > > Update: I spoke with my doctor and informed him that another health care professional brought the Lisinopril/coughing connection to my attention… he wanted me to start taking the Lisinopril AGAIN to be certain that the drug was actually causing the cough. :rolleyes: > > I told him that I wouldn’t be returning. He didn’t say anything to that, just told me to call if there were any other problems, and asked me if I needed another refill on my cough syrup. … I’m off to find a new doctor. > [@Jackmannii](#): > > O.K., that’s dumb of your doctor and good confirmation of the wisdom of finding another physician. … Agreed. Look, speaking as a doctor - we all make errors. There is not one of us who has not been guilty of any of a wide variety of [cognitive errors](http://www.merckmanuals.com/professional/special_subjects/clinical_decision_making/cognitive_errors_in_clinical_decision_making.html). (I’m not sure whether this one counts as “premature closure” or an “anchoring error”.) Recognizing that something is not what you had been thinking it was, clearing the mental slate and reopening the diagnostic process when it no longer fits your initial assessment, is sometimes a hard skill to achieve, and many stay stuck on an initial assessment long after it would be clear to a fresh set of eyes that it is not the best diagnosis. Sometimes it happens after we’ve already had a long enough relationship with our patient (or often in my case as a pediatrician, with the parents) that we are forgiven on the basis of a past track record; it’s harder when it begins the relationship. But in any case the manner in which the doc responds to the realization of an error gives you a measure of his or her worth. What you describe is not placing his worth very high. ---
**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\ **Post date:** [January 27, 2012, 4:45am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/36 "2012-01-27T04:45:31Z")
Well, for what it’s worth, I had the Lisinopril cough too, but it was more of a tickle that would make me cough somewhat frequently. No coughing spells, no hacking, etc… However, when I told my Dr. and explained that I was neither congested nor coughing anything up, she said “I bet it’s the Lisinopril” and prescribed me Losartan instead, which is generic as I understand it, the preferred 1st-line treatment option for people who don’t tolerate ACE inhibitors so well. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [January 27, 2012, 5:09am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/37 "2012-01-27T05:09:10Z")
> [@bump](#): > > Well, for what it’s worth, I had the Lisinopril cough too, but it was more of a tickle that would make me cough somewhat frequently. No coughing spells, no hacking, etc… > > However, when I told my Dr. and explained that I was neither congested nor coughing anything up, she said “I bet it’s the Lisinopril” and prescribed me Losartan instead, which is generic as I understand it, the preferred 1st-line treatment option for people who don’t tolerate ACE inhibitors so well. I think that’s a ARB (like what I’m on now - Benecar). They’re _somewhat_ similar to ACEs, I gather they interrupt the cycle somewhere upstream (or downstream?) of where the ACE inhibitors do, which makes it less likely that it will have the byproducts that cause the coughing… or something. In my case, it felt like a tickle or an _itch_ on the _inside of my neck_. I told the doctor I was beginning to have some very weird fantasies involving a bottle brush :D. My doctor _also_ prescribed some codeine cough syrup - but just as a brief stopgap until I got in to see her (and it did help but obviously not a long-term solution). I’m really confused at a doctor who will offer refills of that apparently in lieu of finding out what the real problem was!! ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [January 27, 2012, 5:13am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/38 "2012-01-27T05:13:06Z")
> [@smaje1](#): > > You misread my OP, Musicat. The cough will NOW take three months to go away now that I’ve discontinued the drug. I am still coughing. And not sleep. And pissing myself with every hack… It shouldn’t take that long, at least I hope not. In my case I saw a response within a week of stopping the stuff. Crossing fingers that it’s similar for you. In the meantime, you _can_ use that codeine cough syrup if you still have any - just the usual cautions about not too much, not too long. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 27, 2012, 5:19am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/39 "2012-01-27T05:19:10Z")
> [@PunditLisa](#): > > You’re putting all your faith into an Urgent Care doctor who saw you for…what? 15 minutes? > > By all means, change doctors if you’re unhappy with the care that your current one is providing. But don’t assume that Doctor B is correct based on nothing more than his opinion. Go off the medication to see if the symptoms alleviate, and THEN you can more safely draw conclusions. UC doctors see a much-wider variety of conditions than most others; they do things like “think of side effects” much more easily. Heck, I once diagnosed my mother’s elevated transaminases as having been caused by her cough syrup… the doctor knew she’d been taking it but hadn’t realized a syrup called actithiOL which stated all over the box and bottle “not for children under 12” might, just might, have some alcohol. They’ve lowered the %, but back then it was equivalent to vodka. In that case, the doctor’s reaction was: “kick me! :smack: OK, you should be fine, then, we’ll repeat the test in a month to make sure it was that and I hereby vow to be a lot more careful about excipients and side effects… damn!” ---
**Author:** ![kittenblue](https://avatars.discourse-cdn.com/v4/letter/k/ba8739/32.png) [@kittenblue](https://boards.straightdope.com/u/kittenblue)\ **Post date:** [January 27, 2012, 6:26am UTC](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748/40 "2012-01-27T06:26:44Z")
I have been on Lisinopril for YEARS and never remember reading anything about cough in the literature, and while coughing is mentioned in the long line of things my doctor reads off on the checklist each time I come in for a renewal, it’s not emphasized in any way. I only have problems with coughing at night when my throat gets dried out from the CPAP, so I guess I’ve been lucky… But I just got a new batch and haven’t reviewed the prescribing info yet, so I think I shall check this out. But I’m also taking a Beta blocker as well. You all are much more informed on how and why these drugs work…I just take what I’m told to! [Previous page](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748.md?page=1) [Next page](https://boards.straightdope.com/t/doctor-misdiagnosed-my-cough-for-5-months-it-was-the-lisinopril-how-to-confront-him/610748.md?page=3)