I've been thinking of writing this post for a while now but I kept putting it off because writing about how useless a "specialized" doctor can be is such a depressing thing to do...
This doctor is the dermatologist I've been seeing for the past three years. He's in his 60s, soft spoken and has a pleasant bedside manner. Is he competent? You tell me:
One day, back in July, a spot below my left eye started to itch. I blamed it on the seb derm and tried to ignore it but it kept bothering me all day. Next day the spot was slightly inflamed so I put a bit of raw honey on it, which helped, but by night it would get itchy again. By the end of the week the itching had almost gone away but now the spot looked a little wrinkly and puffy and something seemed to be growing on it and, whatever that was, would go away after cleansing/moisturizing just to reappear next day. By day 10 I'd had enough, called the derm's office and told them I had a "
growth right below my eye so itchy it keeps me up at night." Got an appointment for the following week.
When the dermatologist examines my skin (he's wearing magnifying goggles, btw) he starts stretching the skin below my eye with his thumb and tells me that there is no lesion and that the spot looks like a "dermatitis of sorts." I asked if it was seb derm, he said he didn't think so and proceeds to show me how to apply a steroid cream that, supposedly, was going to fix this. "Apply this, very thinly, morning and night, for four days then once a day for four more days. If not 95% improved by then, call my office."
I asked him if he thought that perimenopause would cause my rosacea to progress and he said "Rosacea? Not sure you have that. Maybe pre-rosacea."
(This is the same doctor who had diagnosed me with "vascular rosacea" eight months earlier! - Evidently, he never takes a minute to check his patient's file before he sees them.
)
I asked him if he could check my scalp and inside my ears for seb derm, which he did and said I had minimal scaling on scalp, ears and face were fine.
The visit lasted about 10 minutes. I left his office with a sample of Cloderm.
The following is what he wrote on my file:
Quote:
ENCOUNTER DATE: 08/10/2009
Chief complaint: Growth, corner of left eye - itchy.
SUBJECTIVE:
Patient returns - she has an extremely itchy lesion just below the medial canthus of her left eye. She also points
out to me that the raw honey worked beautifully for her seborrheic dermatitis, although she is now using coconut oil,
which also works.
The area below the left eye - it has been there 3 weeks. Never had anything quite like it.
OBJECTIVE:
A very subtle, ill-defined, pink, scaly, non-keratotic, eczematous, 3-mm plaque below the medial canthus of the
left eye. Stretching of the skin reveals no lesion. Nothing palpable other than mild dryness. Minimal erythema
and scale on the scalp. She has a rosy complexion, but difficult to say whether this is truly rosacea - no
inflammatory papules. She has minimal pinkness.
ASSESSMENT:
1. Lesion below left eye - looks more like a dermatitis and is quite subtle.
2. Seborrheic dermatitis - mild.
3. Rosy complexion - too early to say whether this is vascular rosacea.
PLAN:
1. Discussion.
2. Given a sample of Cloderm cream to apply twice a day for 4 days, once a day for 4 days, and then discontinue
below the left eye.
3. Will leave the followup a bit open-ended - depends on how she is doing.
Nine days later, the "lesion" below my eye was still there so, instead of calling the office, I used the patient online service which is very efficient. Here's my note and the reply from his nurse:
Quote:
Your message, 8/19/2009 12:19 PM:
Hello,
I saw Dr. Xxxxx last Monday. He told me to apply Cloderm cream twice a day for 4 days and then once a day for 4
days and that if the condition had not improved 95%, I should call him right away (I'm sending this message
instead).
I completed the treatment this morning and the condition has only improved 60% and still itches.
Please advise.
Thank you.
Quote:
Dear patient,
Dr. Xxxx said "Ok- use it one time every other day for ten days (ie five applications). If not 98% gone, stop,
call, and I will work you in to check it."
Thank you
Which I did, with same results as the first time around
so, after the 10 days, I went to his office to pick up a sample of
Promiseb and hoping that he'd see me. He wouldn't. His secretary made an appointment for ten days later. :(
When he finally sees me, he puts on his magnifying goggles and starts looking at... the wrong corner of the eye and, of course, does not find a thing. He looks at me and says "Can you show me where the lesion is?" He wasn't kidding, the guy just had no idea of what he was supposed to be looking at! I wanted to kick him in the nuts but pointed at the spot, instead, and he starts to stretch my skin again. He then takes his goggles off and tells me that there really isn't any lesion there. The red line I see is just a capillary and the puffy pouch on top of it was, well, nothing really. "You know, these things just come and go. You shouldn't worry about this."
Really? So there's nothing you can do to make it go away? "Not really," he says.
Really?! 
But that's not what he wrote in his report!
Quote:
ENCOUNTER DATE: 09/11/2009
Chief complaint: Lesion below left eye.
SUBJECTIVE:
Patient returns - she does not think the area below her left eye has gone away and it might be a little bit redder.
I had given her a sample of Promiseb for her seborrhea. Do not really think that it has made much difference.
OBJECTIVE:
She has either a very small milium or a very small syringoma below the medial left eye.
There is a small telangiectasia just underneath it. With gravity, it does create what appears to be a puffiness
there and it makes it look like a lesion. Stretching the skin removes the area entirely.
She has mild, but diffuse rosy complexion with a few telangiectasias. No inflammatory papules.
ASSESSMENT:
1. Vascular rosacea.
2. Seborrheic dermatitis - quiescent.
3. "Lesion" below left eye - at this point in time, I see a small milium or syringoma with a telangiectasia underneath it, but no real lesion.
PLAN:
Discussion with the patient. We talked about the Promiseb and I did not feel there was any reason for her to
continue on that. I showed how the lesion below her eye disappeared with a little bit of pressure. For now, we
will leave everything else alone.
What a waste of my time and money! And what a piece of work this guy is!
Re: rosacea, one day he
assesses "difficult to say whether this is truly rosacea" and the next month he
assesses "vascular rosacea" without even discussing this with me. What made him change his mind? He certainly didn't run any tests and my skin looked exactly the same
both times!
Re: Promiseb, he didn't give it to me for the seborrhea (my seb derm has been completely under control for months now!).
I asked him for a sample because I had read that this non-steroid cream reduced redness and was hoping that it would get rid of my pinkness.
Re: the "lesion," had he mentioned
milium or
syringoma when I was there, I'd have slapped the SOB silly because there was
no milium or syringoma on that spot. None! I had a milium on my temple last year, which I removed, painlessly, with a sterilized needle so I know exactly what a milium looks like (and they don't itch, by the way). And I happen to have two small syringomas under my right eye, which have started to fade away and they don't itch nor do they cause the surrounding area to look like a puffy pouch, for crying out loud! Shame on this guy!
And the "lesion" didn't disappear with "a little bit of pressure," not at all. Every morning, a thin yellowish soft crust would form on it (different from the seb derm scaling/peeling) which was easy to remove during cleansing.
Two weeks after I last saw this dermatologist, I decided to try something that had worked well for me earlier this year, when some weird dermatitis had appeared overnight on the back of one of my hands. My family doctor had no idea what it was, she just nodded when I asked if it could be some kind of allergic reaction
. Not a big deal, as the "rash" was not even an inch in length, but it didn't look like it was going to go away anytime soon so I started treating it with OTC stuff.
First I used hydrocortisone, which made no difference. Then I used Psoriasin gel, which didn't work. Neither did Psoriasin ointment. One night I read online that some forms of dermatitis (other than seb derm) respond to antifungal creams so I bought the cheapest generic antifungal I saw at the supermarket (active ingredient, Tolnaftate) and put it on twice a day. That plus Vanicream & cotton gloves overnight, for a week, did the trick.
So, if the Tolnaftate worked on my hand dermatitis, I figured it could work on the "spot" under my eye. Guess what? It did. I had to put up with an achy eye for about 10 days (somehow my eye reacted to the antifungal) but the blasted "spot" disappeared, finally. Still gone and it's been a couple of weeks now.
My insurance paid this "specialist" close to $400 for two consultations and my copay was $40. And I ended up fixing the problem myself.
That I will never see this jerk again goes without saying but, sadly, he is not the only incompetent/uncaring doc I've seen this year.
Login
Register
FAQ
Search
April 2010
February 2010
