Bus Stop Diagnosis
Sometimes patients present with diagnoses that are so obvious, you know what the problem the moment you see them. Some call these "bus stop diagnoses," because, um, you can diagnose them standing at the bus stop*. Hyperthyroidism with exophthalmos is one; acromegaly and achondroplastic dwarfism are others. Obviously, many skin conditions can also be readily diagnosed from cursory inspection at a distance.
Now and then, though, a diagnosis and a cliche come together like soap and water.
I saw a lovely young lady today with what was probably one of the worst cases of rosacea I have ever seen. Her cheeks were bright red, as was her nose, and sections of her forehead and chin that had also broken out. Even my staff was able to diagnose it, telling me afterward that they, too, had never seen such a severe case.
Surprisingly, though, that was not why she had come to see me. In fact when I asked about it, she claimed that she had never actually been diagnosed with rosacea before.
I slammed my hand over my mouth as the response jumped into my head, but eventually, I couldn't resist, and this is what slipped out:
You've never been diagnosed with rosacea?
Why, it's as plain as the nose on your face.
* (Thank you, Mr. Frank.)