Henry came in leaning on a cane. He rolled up his trousers and showed me his shins, both red and scaly.

That’s not an infection,” I told him, “just a kind of eczema caused by poor circulation. It often comes with age.” I recommended a cortisone cream to get rid of the symptoms of itch and scale.

Wikimedia Commons
Source: Wikimedia Commons

“I’m a diabetic, you know,” Henry said.  He told me the name of the doctor at a diabetes clinic who had referred him.

“I was taking a plane trip two weeks ago, a little after this rash first came in,” he said. “A flight attendant passed by, saw that my pants legs were rolled up a little, and said, “I used to be a nurse. You have cellulitis.”

“I see,” I said. “So because you have diabetes, what she said worried you, because an infection like cellulitis could lead to your losing your leg.”

“Yes,” said Henry.

“That’s why I started off by telling you that what you have is not infected,” I told him. “For one thing, cellulitis happens only on one leg and gets worse fast.  It doesn’t affect both legs and then just hang around and itch a little.

“A lot of people with this common kind of circulation-related rash worry that bad things will happen to their leg, but especially if they’re diabetic. They hear that they may have cellulitis from friends, sometimes even from doctors. Not many hear it from a flight attendant.” 

Stories like Henry’s—they come up often—point to several lessons that are not on the standard medical curriculum:

  • To know what people are truly worried about, you can’t just go by what they tell you. Henry didn’t care about the itch. He was afraid of amputation. Really.
  • If you convince people that their symptoms don’t matter, you may not even have to treat them. Now that Henry is no longer concerned he will lose his leg, he’ll probably stop using the cream in two days. Guys are like that.
  • Even native speakers don’t always understand medical terms, even when those terms are explained in plain English.  When the flight attendant told Henry he had “cellulitis,” Henry knew he had something bad, but not what kind of bad. So even though I began by saying, “This is not an infection,” he didn’t pick up that I was being reassuring about exactly what was worrying him.

It is very easy for medical people to make patients feel worse without really trying.  You can’t blame the flight attendant/nurse for not knowing that Henry didn’t have a bacterial infection. She was not really examining him, and a glance at legs squeezed between airline seats is not much of an examination anyway.  What she was really implying was, “You’d better have that checked out,” which was not bad advice. But what Henry heard was, “You are going to get gangrene and lose your leg.” 

Not quite what you want from the Friendly Skies.

***********************************

Dr. Rockoff’s new book, Act Like a Doctor, Think Like a Patient: Teaching Patient-Focused Medicine, has just been published by Medical Education Press. The book focuses on the need for medical providers to know not just how to diagnose and treat disease, but to understand patient and make them feel better. You can order the book on Amazon.

https://www.amazon.com/s/ref=nb_sb_ss_c_1_17?url=search-alias%3Daps&fiel...

Alan Rockoff
Source: Alan Rockoff

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