Doctors Aren’t The Worst Patients, We’re The Busiest

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Issue Number: 
Volume 12 Issue 5 - May 2018
Desmond Bell DPM, CWS

You have probably heard the adage  “doctors make the worst patients.” This sentiment may rank up there with another general truth that states, “he who acts as his own lawyer has a fool for a client.”  If you don’t yet see the connection that I’m trying to present, please allow me to indulge you with a personal tale of recent events that should clarify the comparison. Before I get into any specifics, however, it should be noted that when I was asked to consider contributing this article to Today’s Wound Clinic, the focus was to be under the premise of infectious disease and wound care. Obviously, that is a broad area for discussion, but as I was ruminating, I thought of the times I’ve heard medical personnel, especially those in the hospital setting, declare that their “immune systems are incredible” or that they are “likely colonized with MRSA [methicillin-resistant Staphylococcus aureus].” Anecdotally, this makes sense, as we wound care providers can attest, we are exposed to many potentially dangerous organisms between patient encounters and the physical setting of a hospital and wound center. I’ve been blessed with overall excellent health and have tried to maintain a balance where healthful nutrition, stress management, and a basic enjoyment of daily living are never lost upon me. That said, I initially didn’t think much of the small bump I developed on my left forearm about 18 months ago. That was until it didn’t go away. As a Florida resident who enjoys many hours walking outdoors (ie, the aforementioned stress management and enjoyment of living), thoughts of skin cancer began creeping into my mind. To cite another common (and true) stereotype, we Floridians are not deterred by hot summer weather, thanks to the fact that almost every building and vehicle we have access to is air-conditioned. Still, encouragement/prodding/nagging from my family and friends to have the growth surgically removed accompanied my thoughts of potential skin cancer. The surgeon in me would agree that a suspicious skin lesion should be biopsied, with no room for debate. That being said, when was I supposed to find the time to make a doctor’s appointment for an evaluation, make a return visit for a biopsy, and then schedule any potential visits beyond that? I did what I suspect many other medical providers would do: I asked an internal medicine colleague who subspecializes in dermatology for his opinion, but only after I had done a little more reading on possible diagnoses of my mystery bump. I was pretty certain that I had a stubborn folliculitis versus a malignancy; my colleague verified my self-diagnosis. Gradually, the bump seemed to decrease in size, but it persisted over the ensuing months. When spring disappeared, however, the bump had not. Now nearly a year into this annoyance, I figured some topical antibiotic and steroid creams would shrink the persisting nuisance. Some days, things seemed to be improving. Other days, the bump seemed more intense. Late one summer day, about one year post-bump, I noticed some increased erythema and induration surrounding the site. I didn’t like the appearance and became concerned that I could have a bacterial infection brewing. Empirical therapy called for some double-strength Bactrim, which should have taken care of things. Two days of Bactrim later, I was still feeling fine and thinking the bump would soon be gone. That was until two days from that point, when I happened to be working on the computer in the hospital’s doctor lounge, and one of my infectious-disease colleagues happened to be there as well. Not wanting to miss an opportunity for convenient consultation, I showed him the bump, explained the situation, and showed him the new red streaks that were traveling up my arm, accompanied by some new swelling. My colleague laid it out there for me pretty well when he said, “dude, if that isn’t improving in the next day, call me and we’ll get some ‘Vanco’ [vancomycin] going.”  I figured, “dude, the Bactrim is working. I feel fine.” Then, 20 minutes after thanking my infectious-disease brethren, it occurred to me as I settled into my car to drive home that the temperature in the doctor’s lounge had seemed quite cold, even if that were due to the AC being cranked up for another day of high-90s weather. Although the temperature inside my car at that moment must have been well over 1000, as I sat there I actually felt comfortable, like I needed to thaw out a bit from the chill of the lounge. There was no need for AC during that 40-minute ride, but when I entered the house I felt the need to put on a sweatshirt and get under the covers of my bed. Shaking chills had presented in full force and were accompanied by a fever that felt like 1010 at least. (Note that, although I consider myself to be a conscientious healthcare professional, my man cave is not equipped with an “unnecessary” thermometer!) A good night’s sleep was all I needed, I told myself. I couldn’t miss work, as my patients had appointments scheduled and their health remained at stake. In some of these patients’ instances, family members had taken time off to transport their loved ones. If I called out, the ramifications could be serious. So, I managed to get through that next day courtesy of ibuprofen and feeling “much better” than I had the night before. I figured the Bactrim was working and things were almost back to normal. That evening, almost like clockwork, came the return of the shaking chills and the fever.  

Fortunately, I did not have patients to see the following day, and my colleague was kind enough to start intravenous vancomycin over the next three days. There had been no sign of an abscess, although my right forearm was now twice the size of my left. (Seriously, I could have passed for Popeye if it were Halloween.) More fever and chills persisted during the first night of the vancomycin. The second night, I was awakened from a night-sweat-laced stupor with throbbing throughout my arm. Now, anyone with objective medical sense in that moment would have headed to the emergency department (ED) of the nearest hospital. Knowing what I know and knowing how long I’d be out of commission if I underwent the needed incision and drainage, I opted for “Saturday Night (Fever) Bathroom Surgery” by gently pressing on my forearm, causing the abscess that had been hiding to rear its ugly head. Copious pus drained over the next half hour, with more to come the following morning. No culture tubes were available (do you really think they’d be “in stock” when a thermometer was not?), so I’ll never know which specific organisms were inhabiting my arm. I suspect it was MRSA, with a possibility of some beta hemolytic strep thrown into the mix, but I can only surmise. Once the abscess began draining, I truly began feeling better. (I can at least admit now that I was a few hours away from heading to the actual ED, had things not finally improved.) I have performed many incision and drainages over the years in some seriously infected wounds and have enough sense to know when further intervention is needed. I had not lost function of my hand or experienced any paresthesia, no crepitus was present, and I had no pain throughout the episode; so I gambled once more on my responding to antibiotic therapy and my bathroom drainage procedure (there was no incision before the drainage). The next day saw a final round of vancomycin and a significant decrease in the size of my arm.  No further signs of sepsis presented, so a return to work was scheduled for the following day.  However, the episode left me weakened for several weeks with a residual wound on my arm (that is now a granuloma) that is approaching two years since the start of the innocuous bump.  Ironically enough, another infectious-disease colleague recently saw my arm and, after I told him of the events that I’ve just shared here with TWC readers, admonished me. “That’s a granuloma,” he said. “You need to have that removed. The infection can come back.” twc_0518_bell_figure1

Great. Let me check my schedule … Do doctors make the worst patients? I don’t think so. Do doctors have time to be patients? No, they don’t. I’m not going to pontificate, but I will say that despite frequent handwashing/sanitizing and an appreciation of how serious infections can be, I could have easily been in a much worse situation had it not been for the resources available to me. I promise I will have that granuloma removed, not to mention schedule my overdue colonoscopy and prostate exams this year! 

Desmond Bell is founder and president of the Save A Leg, Save A Life Foundation. He is dedicated to lower extremity preservation and has a private practice in Jacksonville, FL, where he specializes in wound management.