In my case, the doc refused to prescribe the antibiotics or run the tests and I ended up on doxycycline for eight months when I finally started to show more serious symptoms and they ran then the tests.
So in all three cases, tests showed that we were positive for Lyme disease, and in all three cases the physicians had botched the diagnosis. A good protocol could have prevented that. On the other hand a bad protocol could have denied us ever getting tested.
My point in saying this is that either proper protocols or physician discretion can be a good thing or a bad thing depending upon the type of case. Had I been the usual compliant patient, the latitude of physician discretion could have been debilitating or fatal. Had there been protocols in place denying testing at all the results would have been just as bad.
Wait ‘till they find out you can’t sue the government!
There will be a dimunition of malpractice justice for deserving patients, and, consequently a drop in quality of care...that is, among the doctors who will buy into this system, which will be extremely diminutive.
The surgeons who finally came to visit asked me why I waited so long....
“Both my kids and I were (upon separate occasions) nearly condemned to denial of treatment for Lyme disease simply because the physicians involved did not believe that the Brucellosis bacterium was in our area. They showed the classic bulls-eye rash but the docs would not run the tests. A proper protocol would have saved me a ton of trouble in getting us to an infectious disease doc. When I finally did, his comment was, “Good job.” The tests showed that the kids were positive.
There is no substitute for a careful history and physical, critical thought, and asking for help when you are in over your head.
In my case, the doc refused to prescribe the antibiotics or run the tests and I ended up on doxycycline for eight months when I finally started to show more serious symptoms and they ran then the tests.
So in all three cases, tests showed that we were positive for Lyme disease, and in all three cases the physicians had botched the diagnosis. A good protocol could have prevented that. On the other hand a bad protocol could have denied us ever getting tested.
My point in saying this is that either proper protocols or physician discretion can be a good thing or a bad thing depending upon the type of case. Had I been the usual compliant patient, the latitude of physician discretion could have been debilitating or fatal. Had there been protocols in place denying testing at all the results would have been just as bad.”
I am glad that you and the kids were diagnosed and treated correctly. (BTW, the agent of Lyme is a Borrelia, not Brucella).
You are correct that the appropriateness of treatment is based on how well the algorithm is written. It is likely that the algorithm for a skin rash for a Nurse Practitioner in San Diego would likely be very different for one in White Plains, NY.
In San Diego, where there are very few cases of Lyme Disease reported annually, treatment for wasp or spider bite would likely be the protocol-directed “Correct” treatment. In White Plains, which lies in one of the most heavily Lyme-endemic counties in the Northeast, the protocol would likely (correctly) direct the NP to treat for Lyme Disease based on the appearance of the rash alone.
You are also correct that an early referral to an ID specialist would likely have unravelled the story earlier and saved you unnecessarily prolonged treatment.
We are trained to evaluate people based on history of travel, occupation, exposures in a way that you don’t get when people are following protocols. Medical diagnosis is very much a function of complex pattern-recognition, but you won’t see the pattern unless you take the time to get all the information. And, as I am wont to tell my students and residents, “When all else fails, LISTEN TO THE PATIENT!”
A few years ago, my friend’s daughter drove cross-country from her Connecticut home to California. By the time she reached Las Vegas, she had a peculiar blistering rash behind the knee. She was given steroids for a spider bite. She texted a photo to me, and it was clearly a typical rash of Lyme, which often blisters behind the knee.
I phoned in an Rx for doxycycline, and obtained a confirmatory blood test (positive) when she arrived in California.
Now, if the Las Vegas ER doc had trained in the Northeast, he might have made the diagnosis. But based on his experience, the low prevalence of Lyme Disease in Nevada, and the ER prorocol there, the correct diagnosis was missed.
I've seen way too much of doctors dealing with the effects rather than the causes. It's why I avoid doctors; they've done so much harm to so many people not treating these underlying causes.