Does This Frustrate You?

I was talking to a patient the other day about the problems she was having with her feet. The symptoms didn’t seem to be consitent with any musculoskeletal trauma and the presentation was a little vague (generalized pain but in the joint line, kind of achy, hurt at random times, etc.) At the same time, she has also been complaning  that her psoriais is acting up. This sparked a thought in my brain that she may be suffering from psoriatic arthritis. 

I told her to look up some information and also to talk to her MD about it to see if he woul do any follow up testing. She reported back later that when she mentioned it to him he said, without even examining the foot, “I dont’ think it’s that.” To which the patient replied, “What do think it is then?” The doctor said, “I have no idea.” 

WHAT? How can you say it is not something but also say you have no idea what it is? Does this make sense? If it were completely out of the range of possibilites like, “Hey doc my ankle hurts do you think I may have been bitten by a cobra while in bed last night (assuming you don’t live in India)?,” then I could see answering the way he did. But please, give the patient a break! At least tell her why you don’t think it is psoriatic arthritis. Better yet, try diagnosing for real before you rule out something. Frustrating!


  1. lots of mds don’t appreciate having their patient come to them with a diagnosis from a dc. it’s an ego thing, i think. they don’t like self-diagnosis, either. but sometimes we just know. i love an md who puts some faith in the patient, rare though that may be.


  2. If your patient would have asked the MD what was wrong with her foot, he might have come up with the same dx. But she undermined his authority by suggesting it herself. And you just don’t do that in the medical world. Okay, that is a blatant generalization, but I bet it’s true.


  3. I’ve had the same experience as Michal. However, I think the MD world is starting to come around to the benefits, ones they can’t produce, of Chiropracic care. I think it’s about time.

  4. Sometimes you gotta laugh so you don’t cry. Hey celebrate that the doctor did not pump her full of pain meds or prescribe a “placebo level” of tylonol just to shut her up.. or worse yet…. prescribe her a “mind med” to treat her as a psychiatric patient becaseu she was complaining about something beyond the scope of his understanding or insight! She needs to count her blessings!

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