These are the thoughts of a cantankerous ol' gynecologist who remembers when things were a little different. I try to find a little humor in my life and the people I meet along the way. Come meet the characters in my world.

Thursday, September 1, 2011

Oops, you need to see another doctor…

          I saw a patient the other day that had a diagnosis from her dermatologist of lupus.  This connective tissue disease is usually managed by a rheumatologist.  Now, many internists can manage these diseases.  However, this woman is having many different problems that may be related to the lupus.

          I was doing a “review of systems”.  She was having problems with her eyes, her stomach, and other issues.  Since these problems had started at different times, nobody had put them together as possible symptoms from the lupus.  She had seen her medical doctor for each individual problem and the dermatologist for the rash. 

          Because I generally see my patients once a year, I ask for a summary of what has happened since the last time they were in my office.  I have also adopted the dreaded EMR (Electronic Medical Record), which means that I have to review the entire history and enter it in my computer.  So I am catching things that I might not have noticed before.  {Dang it, I guess maybe there is a reason for those EMRs after all – don’t tell anyone I said that}

          The dermatologist did not refer her for treatment of the lupus.  He just gave her a cream for the rash.  The internist has been treating her symptoms as they present, not knowing about the lupus.  Sooooo….

          Screech.  Put on the brakes.  Stop everything. 

          Unfortunately, I have only general ideas about what to do here.  It’s not in my “scope of practice”.  Remember – I’m a gynecologist.  However, I do know where to send her.  I’m good at identifying when someone needs to see another specialist.  She may need some different medication, testing, or other fancy stuff. 

          As we were discussing her hot flashes and the possibility of hormone treatment, we decided she would hold off until she saw the rheumatologist.  These could be related to the lupus.  Or NOT…..  So she might be back for more discussion about menopause issues if the hot flashes and night sweats are not related to the lupus. 

          But first I have to fill out that danged referral form.  You know how I feel about forms……

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