At what point would YOU see your doctor?
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Loading ...Here’s a small clinical vignette for you:
A 43-year-old man with no significant medical history presents to his primary care provider (PCP) complaining of a “wound that won’t get better” on the left side of his neck. He states that the wound has been slowly growing over the past 2 years after it first appeared as a small pimple. In his efforts to heal the wound, he has used a variety of over-the-counter topical remedies such as hydrogen peroxide and triple antibiotic ointment; however, the wound has continued to spread and worsen. He was finally encouraged to visit his PCP when his brother noticed the now several-centimeters-long lesion (Images to follow). The patient denies having weight loss, fevers, or chills. He has not traveled during the past 5 years.
On physical examination, the patient is somewhat overweight. His vital signs are normal except for a blood pressure of 165/93 mm Hg. The patient has a 10-cm ulcer at the collar line on the left side of his neck. A homemade dressing that the patient had placed on this lesion contains a small amount of serosanguineous fluid. No lymphadenopathy and no masses are noted around the neck or in the armpits.The rest of the physical examination findings are unremarkable, except for numerous small hyperpigmented macules on the patient’s chest and back.
What is the most likely diagnosis, and what is the diagnostic test of choice?
Now go here to see the images and the dx (warning: wound images for the non-medical readers).
His brother says, “Dude, I think you need to see a doctor about that.” Gee, ya think?!? How can this guy go two years with that thing on his neck? Remember, this thing started as a “small pimple.” At what point, packing it with 4×4s, does one finally say, “You know, this pimple might not just go away.”??? You’d think the 75L of hydrogen peroxide he’d bought over two years would have at least kept it from getting, you know, “icky.” At least the triple antibiotic ointment kept the granulated tissue nice and moist.
These are the kind of patients that walk out of the room saying stupid shit like, “You see?! That’s why I don’t go to doctors; they don’t give you nuthin’ but bad news. They just want your money. Plastic surgeon, my ass! Although a boob lift might make me look younger…hmmmm…”
'Net Finds, Medical and Health | enrico | 
May 30, 2007 10:13 pm
By Fat Doctor, June 3, 2007 @ 6:30 am
Super scary story (and images!). I
saw a pt once with a strong fam hx breast CA (sisters and mom). When her own breast started falling off in chunks, she just put gauze over it and wrapped her entire chest with an Ace bandage. What did she see me for? An ingrown toenail.
She figured she was going to die from the breast CA and didn’t want to go through treatment for that (said her sisters and mom both died despite agonizing chemo/radiation/surgery), but she wanted to be able to walk pain-free until she was actively dying.
We had to involve ethics team on that one, because I really, really, really didn’t feel I could just say, “Oh, OK.” At this stage in my career, I would be more comfortable with a patien’ts autonomous decision being not the one I’d make.
-FD
PS: Thanks for your blog help by phone yesterday!