Posted by: notdeaddinosaur | November 13, 2006

The Insult

I have a very thick skin. I rarely take offense at things patients occasionally say to me, because most of the time I understand that they don’t mean to insult me. But the other day I heard something that left me speechless (truly an unusual event) with indignation.

A man in his late 20′s presented as a new patient for treatment of his asthma. As is my usual practice, I took a full medical history. The patient, who did most of the talking, was very self-assured as he related his history. For example, he didn’t want Ventolin because he was afraid it would give him heart palpitations, but was insisting on Advair for treatment of his acute bronchospasm. (Quick explanation: Advair is a long-acting bronchodilator/inhaled steroid combo, NOT appropriate for use as a rescue med for asthma.)

In the Past History portion, he related a history of back problems and a course of treatment for “chronic Lyme disease” (a condition that does not exist, according to all reputable Infectious Disease experts.)

At this point, I should relate that I am quite tolerant of these kinds of announcements. My feeling is that immediately and spontaneously holding forth on the ridiculousness of useless medical therapies is not particularly conducive to good rapport-building with a new patient. When asked, of course I share my opinions; but when patients are merely relating what they’ve already been through, I just listen.

He went on to tell me that he was still in treatment with a specialist: an LLMD. Did I know what that was? he asked.

Unlike many other physicians, I have never been afraid to say, “I don’t know.” I look at it this way: who do you find more impressive: the person who tries to fake it when they don’t know something, or the one who comes straight out and admits it? For what it’s worth, many patients have been very impressed with me for being able to say, “I don’t know.”

I had never heard of an LLMD, and I told him so without hesitation. It was his answer that floored me:

“Lyme Literate MD.”

So now my refusal to believe the woo of Lyme rendered me “illiterate!” I was too startled to say anything other than, “Oh.”

I talked him into a Xopenex prescription for his asthma (he flatly refused any form of albuterol) and somehow managed to contain my fury until after he left.

I hope he doesn’t come back.


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