Fortunately for my patients, my greatest mentor in the art of medicine, a D.O., taught me that identifying the correct diagnosis is at least 50% good history taking, that having phenomenal physical assessment skills and using them is critical, and that tests are used to “confirm,” a diagnosis.

Someone has to stop the litigation insanity somewhere. Telling patients that you aren’t doing a test because they don’t need it at that point is fine. Telling them you will consider that test later if they aren’t getting better is reasonable, thoughtful medicine. The problem with this approach of course, is that it requires thoughtful, effective communication with your patient. I think these posts demonstrate how that goes sometimes…

Would that be the ER doc who told the patient to call an ENT, or maybe a neurologist who saw the patient first (on referral from the ER) and referred on to the ENT? Of course after an MRI and CT Scan. What you’re missing, Kranky, is that Family Docs and Internists are a dying breed and most patients that get referred in my “hood” are given your phone number by an overwhelmed ER doc. You better relearn your primary care medicine cause the patient you see next week probably won’t have a “personal physician”

His best excuse at ignorance outside of the neck is “Someone else should want to do it”. Huh?

I doubt he is turning off the lights in the exam room and transilluminating sinuses. No, I am sure he is ordering CT scans and looking endoscopically while charging ridiculous $$. Why?,because it is better technology. Likewise, listening with a stethoscope for heart murmers is largely a waste of time when echo is better technology. What a boob. He must be the same ENT that takes call at my hospital. In five years of practice I have probably called ENT into the ER 5 times to actually see a patient. Mind you, they have extorted a stipend for the hospital for having their name placed on the call list. Last time I called he said, “You really ruined my day, I was just going out for a bike ride”. If I were responsible for what the patient presented with I would go find a nosebleed everyshift that won’t stop with bilateral anterior and posterior nasal packing just so I could ruin his bike ride.

I agree, the topic at hand is history and physical. As one smart patient saidabove, the H and P is one important tool that should guide you to order technologic tests wisely so you know how to interpret the results in proper context.

I only had ankle surgery 5 weeks ago, so it’s too early to tell if it worked or not. The orthopedic surgeon told me it could be several months until the swelling goes down, and the nerve heals, before anyone can tell if it worked or not. I knew this going into the surgery.

Dr. Hoadley wrote: “You just happen to be an atypical case because you weren’t also demanding the investigation be done just because it happens to be possible”

You are correct. I didn’t want to have the initial spine CT scan and tried to convince my family doctor not to send me for it. I tried to convince her that something was wrong in my legs, and I even had her examine my ankles. I also tried to convince her not to send me to a neurosurgeon. To even get an appointment with the neurosurgeon, I had to have a spine MRI, which is why I ended up having one.
The third and fourth neurosurgeons did notice the inconsistancy between the pattern of pain I was reporting, and the pattern that would be expected with having an L5 herniation. I’m not certain why they didn’t consider that I might have a problem in my legs, rather than a spine problem.

The rehab specialist who figured out I have an ankle problem told me that he had problems with heel pain. Perhaps that’s why he focused on examining my lower legs so much, and had some knowledge of the ankle condition I have.