Monday, December 13, 2010

No Respect I tell Ya

Sometimes I non primary care physicians respect our opinions? Do they believe in us? Are we piers or inferiors? And in general....what do we deserve.

I was rounding in the hospital on my partners patients when I came upon Mrs. S. She was having progressive hip pain and her rheumatologist ordered and MRI which showed a joint effusion. The patient developed low grade fevers and anemia and was sent to the hospital to rule out infection.

A quick review of the labs showed the esr and crp were moderately elevated. She was anemic. Her rheumatoid factor and lupus testing were normal. The joint fluid from the hip was tapped and was not consistent with infection.

So I sat down with Mrs S and started to take a history. Upon further review she had also developed bilatteral shoulder pain. Worse in the morning upon waking. Better with activity. She had moderate fatigue.

Based on the clinical history, labs, and radiology findings, I felt the growing suspicion that this was Polymyalgia Rheumatica. So I called the rheumatologist and discussed with her my findings. I felt pretty certain. The conversation went like this...

This looks like polymyalgia....

No I doubt it...probably viral!

But what about the story doesn't fit for PMR?

It just doesn't...lets keep her off steroids and see what happens!

The patient was discharged from the hospital and later followed up with my partner and the rheumatologist.

A few weeks later I ran into her in my office. Upon asking her how she was doing I got this response:

Wonderful Dr. Rheumatology realized that instead of an infection I have Polymyalgia Rheumatica...I am doing so much better now on steroids!

No respect I tell respect.

1 comment:

KimSetser said...

As sad as this post makes me, it was comforting to me to know that I'm not alone. I am a nurse practitioner who left primary care to be a hospitalist, and that was much of the reason. It even happens with my own family; recently, a close friend who had some GI issues spent a lot of money to have an EGD, only to tell her what I had been telling her for a couple of years (I worked in GI for a few years before primary care). Of course she didn't remember that I had told her the same things and now is getting better by following the advice of the "specialist." Ho hum.