Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, October 28, 2008

Definition of a Specialist

Here is my new definition of a specialist:
One who, when confronted with a horse, insists on continuing to look for the zebra.
This patient, apparently not satisfied with my management (I think it was the family, actually), went to see a neurologist for a problem that dozens of people on the internet were able to correctly diagnose sight unseen.

The neurologist proceeded to order ten thousand dollars worth of studies, including an MRI to rule out a mass lesion, carotid studies and a whole pile of lab work. Eventually I get a letter that says, among other things:
...this could be Ramsay Hunt...
but of course we need to rule out everything else as well.

No wonder our healthcare system is going down in flames!

3 Comments:

At Tue Oct 28, 08:54:00 AM, Anonymous Anonymous said...

I think they consider it job security. If they always said we were right, there would be no reason for their existence.

 
At Fri Oct 31, 08:44:00 PM, Anonymous James Wilk, MD said...

For crying out loud! There is NOTHING--and I mean NOTHING--that the combination of facial nerve palsy with ipsilateral oropharyngeal and auditory canal vesicular lesions could be other than Ramsay Hunt syndrome. There is no "differential diagnoses" there is only THE diagnosis. What a waste!

 
At Fri Oct 31, 09:57:00 PM, Blogger #1 Dinosaur said...

@Dr. Wilk: Just to be fair, would that still be your opinion if you were seeing it two months later when all that remains is the dense facial nerve palsy? The ear is now clear (although in all honesty, I never saw vesicles in the ear initially; the pinna was huge, red, hot and painful, which was what threw me off. I still had to call it "otitis externa" which I think made the internet diagnosis easier. Frankly, that's why I was afraid to give steroids; I was certain I was looking at a nasty bacterial infection, and was just thrown by the vesicles on the palate.) And who knows how much accurate a history the patient gave? Still, thanks for weighing in. I agree, it's a waste.

 

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