I don’t know what you mean by “specifically requesting the differential diagnoses”. Care to elaborate?
I just had a conversation with an urgent care doc. I told the office I had a new ear infection, so they wouldn’t look at my previous doctor’s notes saying I’d been “somatizing” the ETD, and in the hopes that letting them come to the conclusion themselves would prevent them from having an allergic reaction to a patient’s “self-diagnosis”.
That worked, insofar as the doctor said he saw inflammation in my nasal passages and lymph nodes that looked like ETD. He explained what that was, and said I should try a nasal steroid. I said I’d tried two kinds [ Flonase and Nasacort ] and I’d been taking them for seven months, and the problem just kept getting worse. He said I should try a third kind of nasal steroid. I asked if I could try an antibiotic. He said no, he hadn’t seen any signs of infection, and thus he couldn’t conscion the risk of antibiotic resistance. I begged as sanely-sounding as I could. I said “I don’t have allergies [ that could be causing the ETD ]”, but he didn’t seem interested in determining the cause of the ETD in the first place. He said no three times to my request to try an antibiotic, and repeatedly said “Steroids are the treatment for ETD”.
I now have a follow-up with my new GP on Thursday. If you know magic words I can say to make that go better, I give you the floor.
I genuinely do not have the money at the moment to get my head scanned or pursue other options without a referral, unfortunately.
asking about differential diagnoses is the doctor-ese way of saying “ok if it’s not what you think, what else are we considering as possible explanations?” which opens a conversation about whether it’s appropriate to also test for those alternatives. Differentials should include the unlikely stuff as well as the likely stuff, and using the professional terminology can signal that you’re capable of understanding that it’s probably a likely thing but could be an unlikely one.
and if you end up in that same conversation about “no signs of infection”, definitely inquire what signs would be externally perceptible. had he been able to actually examine the affected tissue and culture for bacteria, or was he just guessing?
No tissue samples, just external examination. Not even bothering to guess at a cause. “ETD → use steroids to treat”.
If the new GP acknowledges that I have signs of ETD and that it must be caused by something, and that something is probably not allergies [ otherwise the steroids plus azelastine plus certrizine would likely have done anything long-term, and/or I would have any other signs of seasonal allergies to speak of ], that’ll be mission accomplished. So I’m trying to brainstorm ways to force him to acknowledge that syndromes have causes, which is not a standard most doctors I’ve ever talked with in this great state of Iowa have met.
Update: The new GP took one look in my ear and said, and I quote, “You have a lot of . . . infection!”
And was baffled that urgent care hadn’t given me antibiotics.
I imagine it had gotten significantly worse over those few days [ it had subjectively ], as I hadn’t been able to stay supplied with garlic.
I’m now on doxycycline 200mg/day; Google says ear infections are usually caused by Streptococcus pneumoniae, and that this strain in America is resistant to tetracyclines around 1⁄5 of the time. But new GP said if it didn’t work to come back and he’d try something else.
So barring further complications I seem to finally be in the clear.
New doc has been in the area for a while but doesn’t look/talk like he’s from around here; I would hazard a guess that’s why he was a lucky roll.
I don’t know what you mean by “specifically requesting the differential diagnoses”. Care to elaborate?
I just had a conversation with an urgent care doc. I told the office I had a new ear infection, so they wouldn’t look at my previous doctor’s notes saying I’d been “somatizing” the ETD, and in the hopes that letting them come to the conclusion themselves would prevent them from having an allergic reaction to a patient’s “self-diagnosis”.
That worked, insofar as the doctor said he saw inflammation in my nasal passages and lymph nodes that looked like ETD. He explained what that was, and said I should try a nasal steroid. I said I’d tried two kinds [ Flonase and Nasacort ] and I’d been taking them for seven months, and the problem just kept getting worse. He said I should try a third kind of nasal steroid. I asked if I could try an antibiotic. He said no, he hadn’t seen any signs of infection, and thus he couldn’t conscion the risk of antibiotic resistance. I begged as sanely-sounding as I could. I said “I don’t have allergies [ that could be causing the ETD ]”, but he didn’t seem interested in determining the cause of the ETD in the first place. He said no three times to my request to try an antibiotic, and repeatedly said “Steroids are the treatment for ETD”.
I now have a follow-up with my new GP on Thursday. If you know magic words I can say to make that go better, I give you the floor.
I genuinely do not have the money at the moment to get my head scanned or pursue other options without a referral, unfortunately.
asking about differential diagnoses is the doctor-ese way of saying “ok if it’s not what you think, what else are we considering as possible explanations?” which opens a conversation about whether it’s appropriate to also test for those alternatives. Differentials should include the unlikely stuff as well as the likely stuff, and using the professional terminology can signal that you’re capable of understanding that it’s probably a likely thing but could be an unlikely one.
and if you end up in that same conversation about “no signs of infection”, definitely inquire what signs would be externally perceptible. had he been able to actually examine the affected tissue and culture for bacteria, or was he just guessing?
No tissue samples, just external examination. Not even bothering to guess at a cause. “ETD → use steroids to treat”.
If the new GP acknowledges that I have signs of ETD and that it must be caused by something, and that something is probably not allergies [ otherwise the steroids plus azelastine plus certrizine would likely have done anything long-term, and/or I would have any other signs of seasonal allergies to speak of ], that’ll be mission accomplished. So I’m trying to brainstorm ways to force him to acknowledge that syndromes have causes, which is not a standard most doctors I’ve ever talked with in this great state of Iowa have met.
I hope it went ok!
Update: The new GP took one look in my ear and said, and I quote, “You have a lot of . . . infection!”
And was baffled that urgent care hadn’t given me antibiotics.
I imagine it had gotten significantly worse over those few days [ it had subjectively ], as I hadn’t been able to stay supplied with garlic.
I’m now on doxycycline 200mg/day; Google says ear infections are usually caused by Streptococcus pneumoniae, and that this strain in America is resistant to tetracyclines around 1⁄5 of the time. But new GP said if it didn’t work to come back and he’d try something else.
So barring further complications I seem to finally be in the clear.
New doc has been in the area for a while but doesn’t look/talk like he’s from around here; I would hazard a guess that’s why he was a lucky roll.