Posted by: notdeaddinosaur | July 30, 2011

Overkill

I saw a lady with a boil. It began as a small red bump which got bigger and harder, then drained white stuff, and was now getting better.

The reason she was worried about it was its location: it was on her breast. This was why the chief complaint officially read, “Breast lump” despite the fact that it was technically no such thing.

I examined her carefully, determining that the pathologic process was indeed confined to the skin and clinically did not involve the actual breast tissue in any way. However because she was of an age for screening mammography, I did take the opportunity to urge her to have it; which she did. The problem arrived with the radiology report:

A marker is placed over the area of palpable abnormality. Mammographic images reveal normal breast tissue with no mass or architectural distortion. The pathologic process is confined to the skin. Recommend surgical excision. (emphasis mine)

Um, no. There is no need for surgical excision of a healing boil, even (especially?) on the breast. It will leave a larger scar than the healed boil, and will raise the cost of this simple medical encounter for a self-limiting condition several thousand-fold. Radiologists of all people are singularly unqualified to give advice about the skin given that the essence of their expertise involves gazing beneath it. I can only thank my lucky stars that this patient trusts me enough (and I have enough confidence in my clinical acumen) to forgo a specialist-recommended procedure. Primaries more timid than I, combined with demanding patients, run up the nation’s tab for such useless procedures on a daily basis.

It’s no wonder we are being bankrupted by medical costs in this country.


Responses

  1. I always found it rather puzzling that a radiologist would feel qualified to recommend treatment options to the physician who ordered the study and has looked at the entire patient with her own eyes.

    Smacks of hubris to me.

  2. This is why I avoid whipping out my titties and waggling them at radiologists.

  3. Mams apparently are difficult to read. My local radiologist in a high malpractice area rec. lots of biopsies.

  4. I don’t know what’s more unbelievable-

    #1 – that any woman would go for a mammogram with a painful boil
    or
    #2- that she got in for a routine screening mammogram that quickly!

  5. @Peggy: By the time I saw her, it didn’t hurt anymore; basically all healed. Regarding the speed of mammography appointments: don’t forget the time-telescoping effect of blogging. I never said how long it took for her to get in for the mammo.

  6. Given that she waited until it was practically healed to see you in the first place, she seems like a person who is inclined to take a laid back approach. That makes her failure to panic over the radiology report make sense. What doesn’t make sense to me is why she came in at all if it was healing by itself…You’d expect to see her at the “This HURTS! MAKE IT GO AWAY!” stage of the infection.


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