That doctor was 100%, totally, WRONG! (mad face)

The BBQ Pit
1

So my 13-year-old son has a weird skin rash around his nose for month, that isn’t acne, and we take him to the pediatrician, who is stumped but who says, “No, it’s not impetigo. He doesn’t have to stay home from school.” Gives us a prescription for ointment, $35.00! Well, we’ve known him for years, and trust him, so we bite the bullet and do it.

A month goes by, the rash doesn’t get better. Pediatrician says, “Take him to a dermatologist.” The one serious dermatologist in town, who makes a point of saying, “I don’t do cosmetic dermatology, only skin diseases,” on Thursday breezes into the cubicle, with an observing Family Practice physician in tow, barely glances at the rash, spends the next 15 minutes delivering a lecture on “peri-oral dermatitis” (when we raise our hand cautiously and, when called upon, venture to point out that “peri-oral dermatitis” is just fancy Latin for “yeah, he has a rash around his mouth”, we are brushed aside while the instructional juggernaut rolls on). When we turn down an opportunity to have our son take tetracycline pills for the next three (3) years (“um–I’m not comfortable with giving antibiotics ‘just because’”), with a shrug we are given a prescription for yet another ointment, this time plain old hydrocortisone with some sulfer/sulfa added, and dismissed. As we stand there at the little window settling up with the receptionist, behind us in the cubicle we hear the lecture continuing…

So.

After only 2 applications of the miracle ointment, Friday and Saturday, ($$$), the rash is much worse. (We’re busy going out of town, so we forget a few times.) Sunday night we tell the kid, “Well, some people are allergic to sulfa–you have an aunt who is. Put some of it on the inside of your elbow tonight, and we will look at it in the morning.” In the morning (this morning) the inside of his elbow is red and puffy. “Okay, kiddo, you’re now officially allergic to sulfa, I guess.” We tell him to wash his face good and get the rest of it off, whatever’s left from Saturday’s dosage. We give him some regular over-the-counter hydrocortisone out of the first-aid kit to try.

So then, 20 minutes later, I finally get around to looking up “peri-oral dermatitis” on the Web, and lo and behold, the first two hits, from the New Zealand Official Dermatology Website, and from the Merck Manual, say that not only does any kind of cream make this worse, but also any kind of STEROID cream will make it REALLY WORSE. So once again he goes upstairs to wash his face, second time in an hour. Some kind of new world’s record. And yeah, after only 30 minutes of hydrocortisone cream on his face, the rash is a lot worse.

So now I’m sitting here really seriously annoyed with this doctor. How could someone who calls himself a serious dermatologist NOT KNOW that (a) cream makes it worse, and (b) steroid cream makes it REALLY worse? It’s not like the Merck Manual is some alternative medicine publication.

The Better Half says, mildly, “Maybe there are other factors at work–after all, he IS the doctor, he’s supposed to know. Maybe what was going through his mind was ‘this couldn’t hurt, and it might help.’” I say, “But it’s obvious that it COULD hurt. Even in darkest New Zealand they know better than to put steroid cream on it, so I think he just was in a hurry to demonstrate his expertise to this other doctor and get rid of me. Also, he knows that people want to go home with medicine, and he didn’t bother to talk to me enough to find out that I was intelligent enough to understand if he said, ‘Creams won’t help this, they’ll just make it worse.’” (And yes, I was the one to take the kid to the doctor. I can get out of the house if I need to. And this was important.)

I say, “It’s as if I went to the orthopedic specialist and he told me to put a heating pad on my ankle.” Every website I’ve visited for foot/ankle injuries says, “Don’t use heat–use cold.”

The rule for doctors is, “First, do no harm.” I think this guy was way out of line. We’re going to just keep it clean and take vitamins for a month and let his body deal with it, and if it still isn’t better, we are definitely going to find another dermatologist.

But at least we did find out that it’s evidently not impetigo, and I even pried a note to that effect out of this doctor. (He was understandably reluctant to commit himself to paper.) I do trust him that far, to know impetigo when he sees it.

And no, I’m not including the pediatrician in this rant, because he couldn’t be expected to know specialist stuff like that. But I do expect someone who bills himself as “the Skin Disease Guy” to know that.

2

Okay, I know next to nothing about medicine, but I had a friend with similar symptoms. Turns out, he had a staph infection (he picked it up while working at a pool for the summer), which took an incredibly long time to heal (with antibiotics, I think). Maybe you could ask about that?
Anyway, good luck with that. That can be a tough thing for an adolescent boy to deal with.

3

We Americans have been socialized into believing that medical doctors are somehow all-knowing. That they are smarter than the rest of us. That they have special powers of analysis and diagnosis that the rest of us don’t have.

Well, it ain’t true!

Of course they have a wide range of arcane knowledge and of course they have much more training and practice in diagnosis than the rest of us. And some of them are truly gifted in the art of figuring out what is wrong with someone and what to do about it. And some are truly gifted in that art and are careful, kind, and loving people who want to help others. And those kind of doctors occupy the most important place in any society.

But I have no reason to believe that the average doctor is any smarter than I am. They may have more knowledge, but I likely have a greater analytical facility than the average doc. After all, I’m studying to be a “doctor,” too. (A Ph.D. in history) Plus, I have self-interest working for me. If it’s my condition, I will try to learn about it.

Yep, there are some smart docs out there, but a lot of them get on their high horse and think they can diagnose anything in 10 seconds, so they don’t really bother to think anymore. Dermatologists might be particularly prone to this. After all, a lot of what they treat is right there on the “outside,” and so much of what they treat is ordinary complaints like zits and severe dry skin. But that is no excuse not to give each and every patient a full and thoughtful examination.

Come to think of it, I once had a dermatologist do exactly what your son’s dermatologist did. Fortunately he was right in the diagnosis and the problem disappeared, but sheesh!

I have a few doctors in my life that I trust. I have been going to the same optometrist for 20 years, and his word is my command. (Except for wiping my glasses with a dry tissue. I do that sometimes. Don’t tell him or he’ll yell at me.)

But most doctors–No way. I have had too many experiences like the one Notthemama described. The worst was the doctor who cheerfully told me “You have Chronic Fatigue Syndrome. There is nothing you can do about it. Have a nice day.” Umm…I didn’t have CFS. I had seasonal freakin’ allergies! (Thank God and Schering Plough for Claritin)

Notthemama–I’m sorry you and your son have to deal with this. Rashes are no fun, especially around the mouth. Good luck finding the right dermatologist. With the right treatment, the rash should clear right up.

4

A misdiagnosis almost killed my son at the age of three. Why? because doctors are fallible. And why is that? Well, my son had Rocky Mountain Spotted Fever. The disease is very rare. My son was in two hospitals during his recovery from the disease and there were only two people on either staff who had ever seen a case. (We had more visitors during that stay than if he was the next King of England. Everybody wanted to see the little fella with RMSF.) Something else I learned about skin rashes…there are a quite a few viral and bacterial infections that may or may not be acompanied by a rash. Two years ago my daughter had Scarlet Fever, it is nothing more than a strep infection with a rash. My girlfriend has had a rash on her leg now for two years, they don’t know what it is. They’ve given her just about everything. She’s frustrated of course.

It is very frustrating to be in a situation like this, compounded by the fact that it is your child. I don’t know about you but when something is wrong with one of my kids I can’t stand it. I’m not saying you shouldn’t be angry. I’m just saying you shouldn’t feel like the Lone Ranger. And the truth is they are just doctors, yes they’ve been to school but they cannot possibly be well versed in every single malady that might befall us, there are just too damned many.

Needs2know

5

Yeah, C3, that was my first guess, too, but the pediatrician said it wasn’t, and so did the dermatologist. There are all kinds of horrifying websites for a new kind of resistant staph; they even have support groups, too. Geez. So far at least (knock on wood) we don’t think that’s it.

6

Green Bean stated: After all, I’m studying to be a “doctor,” too. (A Ph.D. in history)

Ha! I once worked at a place where “mere Ph.D.'s” were most definately not normally called “doctor”, because only the “real doctors” (MDs) “deserved that title”. Of course, I’m sure all the medical doctors who worked at that hospital there so exceptionally talented that they were the only ones who deserved that honor, except, perhaps, the one who got national publicity for taking a lunch break in the middle of an operation…

7

I am currently going through something very similar. About three months ago, some strange yellow patches started growing on my knuckles. I have a bit of chronic dermatitis on my hands that has steadily gotten worse over the years, so I thought this was just an extension of that. Then, offhandedly (ha!) I showed this new stuff to my mom the last time I visited. My mother is a dermatopathologist, and she freaked out. She called the people she used to work with in Columbus, and the next thing I know I have an appointment with the dermatologists (who at the time were backed up until July) within that week. The resident looked at my hands for about ten minutes, and it appeared she wasn’t exactly sure what they were. The attending followed up, looked at my hands for five seconds, told the resident that I had “warts, or something similar,” and they froze all six patches that were big enough to be frozen with liquid nitrogen. I had a follow-up appointment in three weeks to check the healing and see if any of the others had grown enough to freeze. End of story, although my mother had reservations and was feeling like an idiot for freaking out.

So last week, I go back for the follow-up appointment, this time with one of my mother’s closest colleagues as an attending–a man she totally trusts as far as professional diagnoses go. He and the resident must have spent 30 minutes looking at my hands, only to figure out that a) they’re probably not warts, or anything similar; b) they’re not sure WHAT they are; and c) the freezing damaged them so much that they’re going to have to wait a month just to see what happens to them. So I have an appointment in the middle of finals week. Oh, and more than a month after the freezing, they haven’t gone away, just changed color from yellow to pinkish orange. And new ones are growing. It’s a fucking mess, and the doctors are completely stumped. I could have damn near anything, and very few of the options are hopeful–at the very least, it’s something ugly that will probably never go away. At the worst, they’re symptomatic of a systemic autoimmune disorder, similar to lupus, that they can’t really do much about. And there are several things it might be in between.

And of course, had the first doctor taken more than five seconds to look at them, and NOT attempted to freeze them off, I’d at least have an idea as to what the hell is going on with me. As is, everyone’s in the dark.

8

I just read about a conference/study you might like to see.

This is the link, I sent it to someone else yesterday, but now you’ll have to wait a few days. The edition in question is in limbo- too late for Recent Editions and too early for Search Archives. Maybe 3-4 days yet to get there.

http://www.newschoice.com/newspapers/alameda/tribune/ then search for “medical errors”

Front page headline: 5/12/00
Berkeley Conference Examines Fatal Medical Errors
Study: At least 44,000 die a year from mistakes in the US, more than car accidents, breast cancer or AIDS.-National Institute of Medicine.
…A recent Harvard study puts annual deaths closer to 100,000.

It also covers non-fatal mistakes, like mixed up medicines and doctor coverups.

9

That’s actually standard in longer surgeries. Think about it–if it’s you on the table for one of those eight-hour vascular surgeries, would you rather the surgeon a.) hand you off or have you kept stable for 20 minutes or so while he goes and gets a bite to eat, or b.) work straight through without so much as a pee break?

I suppose I should come to the defense of doctors everywhere, but I really can’t. There are some real quacks out there. I do believe, however, that the vast majority of doctors are competent and do the best they can. As much as we want it to be or think it should be, medicine isn’t an exact science.

Green Bean–I agree that the average doctor is probably not “smarter than you”. (In fact, I would say that it’s often harder to get a Ph. D than an M.D.) However, I would say that just about any doctor is more qualified to make medical judgements and decisions than you are, in the same way that you are more qualified to comment on historical matters than the doctor. It isn’t a matter of smarts, it’s a matter of training.

To everyone–if you are concerned about placing your health in the hands of a single physician, I would suggest seeking care at a teaching hospital/clinic. There are several advantages: 1.) You will more than likely be seen by at least three people–student, resident, and attending. You might worry about the inexperience of the resident or student, but the attending is there mainly to make sure that doesn’t affect your care. With three people on the case, they’re less likely to gloss over a subtle physical sign or alternative diagnosis. 2.) Students and residents are more inclined to search for those rare and commonly missed diagnoses (“zebras”, in medical jargon) because they’ve just learned about them in school and don’t have the years of experience telling them how rare they are. 3.) You will probably get the “complete teaching hospital workup”, as we call it–the full spate of lab tests and radiographs that a private facility would find “wasteful”, but a teaching hospital would encourage “for educational purposes”.

Dr. J

10

Notthemama, for what it’s worth, I got the same diagnosis once for a rash around my mouth, that turned out to be an allergy to heavily fluorided toothpaste. If he’s been using the same toothpaste since it started, you might switch brands. Can’t hurt :slight_smile:

Vera

11

Well I agree for the most part. Training is key. But if you have a doctor who is seemingly well trained but can’t think his way out of a paper bag–well he’s just gonna be a bad doctor.

Perhaps I have run into too many stupid idiot doctors who have forgotten all their training and want to lump all illnesses into the three following catgories:

  1. The “here, take these antibiotics” illnesses.

  2. The “come back and see me in 2 weeks if you don’t feel better” illnesses."

  3. The “take off your clothes so I can get a better look” illnesses.

Oh, all right. I’m just kidding about the last one.

I don’t mean to disparage the incredible range and depth of knowledge that doctors must have. My point is that we must avoid falling into the trap of assuming that just because someone is a doctor that he/she is all-knowing and will automatically make the right decisions. This is especially true in the current state of the health care system. We have to become activist consumers or else we will get crappy care.

12

TOday’s present health care situation sucks. The HMO has taken over, and most MD’s out there(please take no offense DocJ), treating illnesses rather than practicing medicine.

I hate my GP. Period. I can’t find anyone else to take HMO insurance, so I’m stuck. I see my GP when I am deathly ill, and only then. I get a cold, I let my body do it’s job. I get the flu, I stay in bed for a few days. I get minor bronchial infections, I take some vitamins, Echinacea, and try to rest until it goes away. What’s the point in seeing my GP when he’s going to give me an antibiotic for every ailment/discomfort I have? Why should I let this guy further the penicillin-resistant microbe cause?

I’ve been misdiagnosed many times. No biggie, they weren’t serious. What I think is MORE serious is the lack knowledge of drug interactions. Once I was prescribed something(I forget what), for my gall bladder attack, and it interacted DIRECTLY with my Tegretol. WHat a tool this Doc was!

Basically, there’s good and bad MD’s out there…you just have to know which is which. One more thing…what I’ve learned in my extensive experience with doctors–use your good sense and judgement and personal knowledge to make sure the doctor wasn’t pre-occupied and missed a drug interaction or something serious. Buy a PDR or a lay drug manula, Etc.

-Sam

13

I once had scabies for two years. I went to about four different doctors before I was given an appointment with a dermatologist who diagnosed it as scabies. The only other person (the 2nd doc I saw) who diagnosed it correctly was a Physician’s assistant! The first man I saw told me it was a rash from being in a hot tub (even though I told him I had never been in a hot tub, ever…in my life!)

And I just recently went in to talk to a doctor about starting a weight loss program and possibly taking a medication to help me get a start on losing the weight. You know what the jerk told me? “You just gotta realize you can’t have that hot fudge sundae every night.” I don’t have hot fudge sundaes even once a month, let alone every night! He is the most insensitive dolt I have ever had the misfortune of trusting with my medical care! It is such a misconception that fat people just sit around eating doritos and cheeseburgers and washing them down with soda and hot fudge sundaes! Grrr, I get angry just thinking about it!

And you should know, I complained about this last guy, and the HMO offered me a letter or phone call for an apology. I told them I don’t want one, I just want this guy to know he totally mishandled this situation, and that in the future he shouldn’t be so damned insensitive.

14

My GP, mentioned above told me that I should judt try to reduce my intake of food…No shit Sherlock!.

He mentioned my weight and how we might have to “do something about it”, and I said “Ya, I think I might be interested in something like Meridia…”, and then he said the above thing to me…

Oy Veysmare…

-Sam

15

Notthemama:

I don’t have any idea what kind of rash your son has. However, for a period of months I had this thing going that cause my lips to, literally, split at the corners of my mouth. Extremely painful.

I discovered, pretty much by coincidence, that it was caused by tartar control toothpaste. If I stay away from that stuff, I have no problems (that is to say…).

Anyway, figured the info couldn’t hurt.

-VM

16

I can’t agree more that doctors can be complete and utter idiots.
While in school, I started getting persistent chest pains. Not severe but the center of my chest hurt around my windpipe. I see the doctor at the student health center. She obviously pegged me as a middle-aged hypochondriacial (sp?) female. She told me the pain was in my head–I was just stressed. I got so damn mad I started crying–I know, stupid, but I can’t help it. My chest continues to hurt.

A few months later I had to go to my allergist. Tests reveal that I have asthma–not severe enough to wheeze audibly. THAT’s what’s causing the chest pain. The sad fact is that I was lucky–the asthma was mild. Suppose I had had a heart attack and the damn doctor just dismissed it as middle-aged hysterical female. That creep was so convinced that everything was stress related she couldn’t diagnose a real health condition right under her nose.

Notthemama–hope your son gets better. Ditto on the toothpaste–flouride makes me have a rash, too.
Drainbead–sure hope you find out your problem and get healed.

17

Gawd:
My PA said the same thing. “You just gotta make a change in your lifestyle and either reduce what you take in or increase your output.”

You mean the reason I am fat is that I eat too much and exercise too little??? You are kidding!!! I never woulda guessed fuckface.

He was willing to give me one month’s dosage of Meridia, but that if he gave me more than that it would be a crutch. Yeah, you know, cause the people that make Meridia don’t recommend you take it for up to a year or anything. Whatta dick. The real kicker? Insurance doesn’t cover Meridia (obesity isn’t dangerous to your health or anything, it is just a cosmetic thing :rolleyes: ) so instead of paying 10 or 20 dollars, they wanted 77. I am a college student, how the hell am I supposed to afford that??? So now, thanks to this idiot and my idiot insurance company. I am now shit out of luck in terms of getting a boost with my weight loss.

I reiterate, what a fuckface. Sorry you had a fuckface too Gawd.

18

I’m so sorry about your son and the frustration you all have to be feeling at the hands of the doctors, who have let you down BIG time, ** Notthemama. **

My youngest son Billy was diagnosed with ‘seizure disorders’ when he was three and the doctor put him on phenobarbital. After THREE years of being on this medication, Doc says, ‘you know, I think we jumped too fast on the medication wagon.’ I stared dumbfounded at him, saying back, ‘We, white man??’ I did what he told me to because he said Billy was in danger of getting seizures so rapidly that he could die, if I didn’t go out and get the prescription for these pills and get him started ‘right away!’

But, I learned a valuable lesson. Look it up yourself. I did so much reading about epilepsy, that when it reoccured when Billy was twelve, the attendees at the emergency room wanted to give him a spinal tap, and got mad at me when I said ‘no, he’s acting like he did when he was 3, except he’s not convulsing, he’s just out of it’ That particular physican even told me home schooling could be the cause! 'scuse me?? They told my husband that I was a hysterical mother, and I agreed with them, so that they better get a neurologist or they would really see some action. They did, and Billy was given intraveneous doses of Depakote and finally came out of it, not knowing where he was, but other than that, he was fine.

Good luck with the rash and the fortitude it takes sometimes when people who resent being questioned are more apt to blow smoke in your face than be real and just say, they don’t know.

19

This miss/wrong diagnosis is a problem discussed a lot in my “social circle” the right diagnosis is what a doc’s education is all about, after all.

You “hafta” go back. Take your book or print out from the internet, the creams and whatever you’ve been given so far and go back. Letting this slide past is a disservice to you and others who see that big mouth doc who gave you that cream.

You’d go back if the car wasn’t fixed correctly or call the roofer if the you new roof leaked during the first rain and your kid is more valuable and more expensive than either of those.

I think some of the young women feel they are going to be a bother or embarass themselves by going back (lots are Southern and know they should NEVER complain) but I say, so what? When are you going to see that guy again? Go back every day until the problem is fixed. It works.

Bring a friend, take them right in to the examining room (say it’s your sister or brother or lawyer) true, you might have to drug your teen age boy but when is he ever going to see this doc again? Never, if the doc gets it right this time. and the friend might help keep any personal remarks out of the conversation.