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.

Thursday, February 18, 2010

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.)


At Fri Feb 19, 06:17:00 AM, Anonymous T4 said...

Then you must love sidewalk cafes. Sitting in the sun, nipping at a beer, every passer-by with even the slightest limp becomes a neurologic patient.

At Fri Feb 19, 10:09:00 AM, Anonymous Anonymous said...

Great post. I'm wondering, in normal circumstances, if a patient does not make bring up a problem that you see, do you ignore it or do you ask the patient about it or tell them?

At Fri Feb 19, 09:47:00 PM, Anonymous just a patient said...

Tell us... plz. If only my mom's doc would have mentioned the irregular lab result that should have followed severe bone pain, my mother may have realized her painful ankle was a fracture.

At Sat Feb 20, 10:38:00 AM, Anonymous Anonymous said...

Re "Thank you Mr. Frank" -- I've taught DD6 how & when to say this -- it's hysterical when she does.


Kensington MD -- still alive & kickin' & trying to exercise exactly the right amount :)

At Mon Mar 01, 08:03:00 PM, Anonymous GingerB said...

I have rosecea. I always had crummy skin and kind of put up with it. Most women don't get the WC Fields nose.

I had my son at the Pediatrician and she told me she thought I should see the Dermatologist.

I did finally make it to the dermatologist where a cheap generic medication got rid of it. Why had I ignored it?


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