Curbside Consults

My uncle was about 45 and had this pain in the side of his hip.  It’s almost always bursitis. 

He asked his best friend and golf partner who was an Orthopaedist what he thought it was. He had been telling him for months to ice it and use Motrin. He even gave him a cortisone injection.  All to no avail. 

But it wasn’t bad until my uncle woke up one morning and urinated and found gross hematuria.  Long story short the hip pain was the presenting symptom of metastatic renal cell cancer to his femur. 

If a regular patient came into the office with hip pain, he would get history, physical exam (hopefully) and an x-ray.  In this case a radiolucent lesion would be seen and the diagnosis made in short order.  

In my uncle’s case the fact that his friend was the guy he was talking to who  didn’t want to be a jerk and make his friend  come into the office was clearly not up to standards.  But it was his friend-he was just trying to do him a favor.  It was no favor.

Of course, the die was cast when cancer got to the femur so my uncle presented with wide spread metastasis. It didn’t really make a difference to his long term prognosis.  But it would have if the metastatic lesion created a weakness that led to a pathologic fracture.

In this case my uncle  had no chance, but both he and his friend the Orthopaedic surgeon felt terrible!

 We all get it.  Weekly, if not daily.  Friends, family, neighbors pull you aside, usually in a low, hushed voice  and say “I have this …” and they want you to tell them it’s ok, or what they  have, or how you should treat it.  A  “curbside consult”. Beware.  You can’t win. 

Usually you just listen perfunctorily for a few seconds (a very poor history) and almost never a physical exam and tell them “It’s probably a … “  and hope they go away quickly.  Most times you are probably right.

You think you are trying to do them a favor and you aren’t.  I always said, “When a patient comes in,  we do a real evaluation and we don’t know them from Adam.”  Why would I do a half baked evaluation with a much poorer chance of actually being right for people I know and love? 

 The right answer is to tell them “make an appointment so I can get all the right information and do a proper job’.”  Most reasonable people understand and do so.  The jerks who are just trying to get free advice (it’s worth what you pay for it) get mad and that’s ok.

But you get the questions so many times that you feel bad telling them “You need to come into the office.”  Beware-there is danger here!  

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