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.