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Subscribe to RSSMissed or wrong diagnoses in primary care may put thousands of patients at risk of complications each year, a new study suggests.
Although mistakes during surgery and in medication prescribing have been at the center of patient safety efforts, researchers said less attention has been paid to missed diagnoses in the doctor's office.
Those errors may lead to more patient injuries and deaths than other mistakes, according to Dr. David Newman-Toker from Johns Hopkins University School of Medicine in Baltimore, who co-wrote a commentary on the new study.
"We have every reason to believe that diagnostic errors are a major, major public health problem," Newman-Toker told Reuters Health.
"You're really talking about at least 150,000 people per year, deaths or disabilities that are resulting from this problem."
For the new study, researchers used electronic health records to track 190 diagnostic errors made during primary care visits at one of two healthcare facilities. In each of those cases, the misdiagnosed patient was hospitalized or turned up back at the office or emergency room within two weeks.
The study team found the type of missed diagnosis varied widely. Pneumonia, heart failure, kidney failure and cancer each accounted for between five and seven percent of conditions doctors initially diagnosed as something else.
Most diagnostic errors could have caused moderate or severe harm to the patient, the researchers determined. Of the 190 patients with diagnostic errors, 36 had serious, permanent damage and 27 died, according to findings published Monday in JAMA Internal Medicine.
One of the difficulties in making an accurate diagnosis is certain common symptoms - such as stomach ache or shortness of breath - could be signs of a range of illnesses, both serious and not, researchers said.
"If you look at the types of chief complaints that these things occur with, they're fairly common chief complaints," said Dr. Hardeep Singh, who led the new study at the Houston VA Health Services Research and Development Center of Excellence.
"If somebody would come in with mild shortness of breath and a little bit of cough, people would think you might have bronchitis, you might have phlegm… and lo and behold they would come back two days later with heart failure," he told Reuters Health.
Most of the missed diagnoses were traced back to the office visit and the doctor not getting an accurate patient history, doing a full exam or ordering the correct tests, Singh's team found.
Cutting down on those errors may require changes in doctor training, for example. One thing patients can do, the researchers agreed, is come to the office prepared to give their doctor all of the relevant information about the nature and timing of their symptoms.
"I do think it's important for a patient to question or observe the doctor," Newman-Toker said. "Ask pointed questions: ‘What else could this be? What things are you most concerned about?'"
In addition, he told Reuters Health, patients should "not just assume that once the diagnosis has happened the first time, that everything is said and done and that it's all over. You just can't have blind obedience to the doctor's diagnosis."
For example, Newman-Toker said, if people develop new symptoms or their symptoms worsen, they shouldn't assume everything is fine because their doctor initially diagnosed something not serious.
Patients should understand there is some uncertainly involved in a diagnosis, Singh said, especially because symptoms and conditions can change over time.
"We need to get patients more engaged in the conversation with the providers," he said. "I think the main message is: how do we effectively (make diagnoses) together?"
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That would be great, if the doctor is willing to take the time to listen and explain. That was not my experience when I was trying to get help for a some serious health issues. I had a well known, "respected" specialist tell me, "I am not going to waste my time explaining your MRI results to you." Another told me, "Well maybe that defect in your skull was always there". I did not find many who wanted to really listen to what I was saying. Hopefully this can change, as no one knows a person's body better than themselves, and can tell when something is "not normal" for them.
I have had horror stories of misdiagnosis several times that threatened my life.
Diagnoses that led other physician down the wrong bunny trail as well.
And when I was finally able to prove these misdiagnoses a lot of damage had already been done.
I'm beginning to trust Google more than some of the doctors.
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Perhaps if they would actually update their information and open their minds we as patients might get treated effectively. I am horrified at the lack of knowledge I see sometimes...some doctors will insist over and over that something, "can't hurt. Those never hurt. It can't be." when it DOES hurt, it can be, and if you took five minutes to read a bit YOU would see it IS possible, DOES hurt, and you are just plain wrong. So patients get humiliated, don't get treatment they deserve and need, and come away feeling demoralized and in pain. It is malpractice in my view to keep a closed mind and not keep up to date. I see this so often and have experienced it. Women aren't treated the same way men are treated, either.
So you go, spend a fortune, sit and wait, and half or more of the time you go home still in pain or sick, without accurate information, and feeling either confused, dismissed, or misdiagnosed. If my plumber didn't fix the problem he would have to come correct it, but if a doctor mistreats me I have to go pay over and over to get mistreated again unless I am lucky enough to have the option to go to several doctors. Perhaps if they stopped taking their old professors' words for things and read current material we could get better treatment. It is shameful to let a patient leave an office feeling dismissed and still ill after not listening and having an open mind and willingness to read and learn. Shameful.
so not only are docs required to get a certain number of CMEs per year, they have to take board exams every ten years to maintain certification
Pain is a tricky thing though. I can understand why you are frustrated. I was just telling someone today that pain symptoms are almost as frutsrating to docs as to patients. Many times a source cannot be found. I do think there are some patients who suffer from chronic pain without an identifiable source--yet the pain is real
However, they are far, far outnumbered by both drug addicts and conversion disorder patients. It makes it difficult for the few that are legit
I have gone to the doctors for almost all of my life with the same complaints and their answers are we just don't know or they want to put me on Zoloft or there are some illnesses that we just have not seen before.
I think that they just do not want to further explore the possibility that some other doctor knows something they don't.
im not sure how you get from your first statment to your second but I will say docs are not a different species of human--they are fully aware that there is a doc out there who knows something they don't
If you think doctors are so bad and dangerous then please quit seeing them. Problem solved.
Patients talking to too many Doctors tends to be problematic: Too little time is allotted for office visits. Too many doctors have rigid thinking, arrogance, and closed minds. They don't like to be questioned. They particularly don't like to be handed a diagnosis and will in response adopt a contrarian attitude. They always have to be right. They don't think of the patient as a customer, a person, or even a patient. Some think of the patient as just a revenue source and a captive audience. They usually can't recall enough from previous visits, even with their records to provide continuity of treatment. Repeat-ability is lacking. They have little accountability and are big on "CYA". They don't collaborate or partner with their patients in identifying and attacking the problems. They tend to be technology and organizationally challenged. Their staffs tend to over run them and their patients.
Did I forget anything?
This is NOT to say there are no excellent doctors or no bad patients. This is about identifying those actors and actions most prone to causing misdiagnoses.
Of course, I don't make mistakes...except writing this posting.
(c) 2013
of course not. Because then my thinking is, why do you need a second opinion? Youve already decided what you have. Its rare those people then listen if the doc disagrees
This is actually a great example of the closed mindedness you were talking about earlier
"This is actually a great example of the closed mindedness you were talking about earlier".
eric-2573068, are you a doctor?
Please elaborate on what you mean by "the example". Is your response jumping to conclusions or did you mean something else? "'Handed' a diagnosis" doesn't alone mean dictated or a closed mind. That would depend on how, why, and the context within which the patient presented the diagnosis and how the patient then conducted themselves. For example, did the patient say, "I think I have..." or "Well, I have these symptoms..., which sounds like...to me", or etc?
If the patient and doctor already have a constructive relationship, when the doctor asks the patient "Why are you here?", a patient's diagnosis may be the most succinct and quickest way in the very short time allotted for the patient to communicate their problem to the doctor and open a collaborative dialogue. In any case, the doctor has many alternatives for effective follow-up. For example, they could take advantage of the opportunity by asking the patient why they think they have that disease. Or, the doctor could say, "The symptoms for that disease are...", "Do you have any of those?" Etc.
If the patient begins the dialogue by describing their symptoms in detail, they potentially embark on a fishing expedition. They are not trained to know what is most important or how to describe "what" to guarantee getting enough relevant information across in time.
The doctor has probably been thoroughly trained to start and facilitate a constructive dialogue with a patient and efficiently develop and manage a program to yield a timely and effective patient outcome. If not, they could and should be so trained to take advantage of that usually very short meeting between the doctor and patient. However, such training can wear out for many reasons and should be subject to refreshes and updates.
I personally refrain from giving "diagnoses", even when asked and particularly, if I am seeking a second opinion, having been given a first opinion by another doctor. If I do (give a diagnosis), I risk the 2nd doctor not using their training and judgment, for whatever reason. I don't provide the first doctor's opinion, until I get that independent opinion or some special circumstance warrants doing so. The downside is that I have left some visits feeling that some useful information may not have been communicated in the limited time allotted.
(c) 2013
If I say yes, I'll either be called a liar or immediately judged to be part of the problem. Seems no win
handing someone a diagnosis before youve even discussed symptoms, let alone possibilities
pretty much
it certainly does not imply an open one. Imagine if you walked into a doctors office on a referral from a PCP. The specialist immediately hands you a diagnosis based on "what he's already read about you in the chart". Now, he may still be willing to hear your symptoms explained, but certainly this behavior might lead you to believe he will not be the best of listners
this was not what the poster said. She said she handed him a diagnosis
Its not if its wrong.
or the patient could just start by listing his symptoms instead. Seems more to the point
thats called medicine. You ever listen to those car guys on NPR? Is that a fishing expedition? They are experts who are trained to translate symptoms into problems with practical solutions. Same with docs. There are patients who rattle off symptoms like the textbook chapter was written about them---thats easy. Then there are patients who don't fit any pattern--those you rule out the most dangerous issue and go from there.
A real fishing expedition is to follow every amateur's guess and webmd diagnosis until ultimately the correct one is found
thats exactly why they should not try to diagnose themselves. They do not know what is important. Thats why they should tell everything to an expert and let him sort it out
This comment represents my viewpoint perfectly. You actually proved my point exactly. I could not have said it better myself.
Eric, I have had doctors tell me that a condition that I have "can't hurt, can't be where you say, can't cause problems, can't hurt, can't be what you say" when I not only had surgery for the same condition many years ago and it was diagnosed and proven that it was indeed what I have again, did hurt and does now, can be what I say, and I can show scholarly article discussing exactly what I am saying, show the exact information from the Mayo and Cleveland Clinics, among other reputable sources, that describe exactly what I am reporting and how it does happen, can be very painful and spread exactly as I describe, and STILL have them insist it is impossible, can't hurt, and isn't what I am saying.
Yes, I know what the issue is, yes, I know my body well, yes, my medical history has this in it and I have scars to prove I was treated for the same thing before, but I have been treated like I was making things up, not bright enough to understand that it "couldn't hurt because they don't", and patted on the back as I was shown the door. Funny that first surgeon gave me relief for many years, but he is retired and others don't seem to be able to read or care that they are just plain wrong.
My experience isn't unusual, actually, and while I know sometimes patients don't know what they think they do, sometimes they actually are right and aren't heard. So now I have a friend who has serious pain and is being treated the same way, and she has no insurance and is being sent back and forth to several doctors who all want to be paid, but not getting any relief or respect. She has the same thing I do and is being treated like crap instead of getting help. She can't do her job any more because of this pain and even the doctors...all dismissing her symptoms as impossible...don't agree on what is wrong while they say it can't hurt. How is that reasonable? There is medical literature on the topic that all of them could find in five minutes, and yes, I did show them...no one would read. I have been told that I am not the doctor and therefore have no idea of what I am talking about. I have been asked if I have gone to medical school as they did. I am not rude, I feel we should be a team, and I am educated about how the human body works. Closed minds. Disgusting.
show me the sources please.
Wow! And you don't consider yourself close minded?
Are you a spin artist for the AMA?
You have proven all of my points. Thanks.
I hope you are not one of my doctors or doctors to be. Moreover, I hope you are not a doctor.
(c) 2013
no, just tired. It was almost 11 pm where i was, and I had worked a whole day and was exhausted. Plus I figured she wouldn't write back so I didn't put a ton of effort into my post
You need to settle down
my office would screen people like you pretty easily. You wouldn't be able to get within ten feet of me. Its not that people like you don't deserve help, its just that usually youre argumentative, defiant, and noncompliant. This takes time away from people who accept treatment
I think your immature actions on this board demonstrate these traits nicely
I have a severly disabled daughter and a husband with a fatal lung disease. Believe me, i go in to appointments with questions and lots of info taken from reliable and credible sources. However, in general, I have trouble getting answers to the questions I ask or am made to feel like I am overstepping my bounds. Doctors don't want to be challenged with an opinion other than their own and they would rather give no news than bad news. I am careful to respectfully listen to what they have to say and am careful in how I ask questions so as not to challenge their opinion but ask about options etc.. When we had the first appointment after a biopsy to get info on my husbands lung disease I could not get ANY info out of the doctor. Even when asking open ended questions. We were just told to come back for another test in 5 weeks and we would talk then. Not good enough! We already knew his disease was fatal and had a prognosis of a few years. We didn't have time on our side! When I asked about lung transplants, I was told that a transplant center would laugh at us if we called them now. However the one I called in NYC gave us an appt. right away and have been wonderful. We don't see him anymore or anyone in his large practice. Until the doctors start treating informed patients and their advocates better, this situation won't improve.
The AMA - - barely out of the voodoo stage.
Been misdiagnosed by two different doctors over the years. Nothing disabling, fortunately. But in both cases it took two years for the doctor to actually hear me relate the list of symptoms and come back with an amended, corrected, diagnosis. In the second case, it led to immediate surgery. Could have eliminated years of suffering and sick time by paying attention in the first place.
do you mind sharing your condition?
I went to Patient First for what felt like kidney stone pain and they sent me to Urologist who said I had blood in my urine, a urethral stricture and a pancreatic mass- after I had a urethral dilation, a CT scan, blood work- I was then sent to a GI doc who did an endoscopy- found nothing. The pain persisted and I went to a Ortho/Pain MD who accused me of being drug seeking and refusing to have an MRI (which my BC/BS refused to authorize). I was sent to each new MD by the previous one. I woke up 3 days later and the pain was gone! I have been an RN for 32 years and I left that last office crying- I haven't been to a doctor since and I feel better than ever.
sounds fishy--ive never heard of a urologist diagnosing a pancreatic mass. A radiologist may have seen something, hard to say
ok...it wouldn't show a pancreatic mass. Not sure how this means anyone is misdiagnosing anything
sounds like you did have a kidney stone--the pancreatic mass may have just been an unrelated finding on CT. Im not sure what youre complaining about here. Maybe you had a stricture, maybe not. Thats the only issue I can see
Eric -- IF you are a physician, or IF you are preparing to be one, and IF you are attempting to add to this discussion by posing your comments as a "professional," what part of your AMA professional Code of Ethics permits you to make, confirm, or refute diagnoses of patients in an online discussion, for anyone you likely have never met in person?
rdo,
have you been living under a rock for the past 20 years? Turn on the radio and you'll find shows like "dr radio" where people call in and get medical advice. Or online, like this very site, where news stories full of health advice are published daily. Those are treatments offered to people who have never met the practioner. Furthermore, I have not claimed to be a dr on this thread. If you take my advice as "professional", thats on you, bub
Im honestly shocked
If a doctor won't answer your questions, find another doctor.
I have sat in an exam room for upwards of half an hour waiting for the doctor to finish with the previous patient in the next room. While I can't hear clearly what is being said, I can tell the the patient is asking questions and the doctor is answering them. The extra wait might be an inconvenience at the time but it is nice to know that my doctor is willing to take the time to talk to his patients and not just hustle them out the door. I might be the next patient to have a lot of questions.
Though I had been to several ophthalmologists over time, it took an optometrist to warn me of potential vision loss due to my severe nearsightedness in my right eye. It took several more ophthalmologists before I was given a diagnosis of low tension glaucoma (optic nerve degeneration) to explain the small blind spot in that eye and I was referred to a "glaucoma" specialist.
While the blind spots grew, multiplied, and spread to both eyes, I was very specifically assured several times by the 2nd of those specialists that I did NOT have narrow angle glaucoma or macular degeneration. I still refrained from medication with narrow angle glaucoma warnings.
In desperation, I sought a 2nd opinion from another glaucoma ophthalmologist. I asked them to start with NO information from my prior physicians. On the first visit they said I had narrow angle glaucoma, caused by mild cataracts and prescribed non-invasive laser surgery in both eyes to open the narrow angle. With that surgery complete, they said I no longer needed to avoid medication with narrow angle warnings and eliminated 2 of the 3 types of eye drops I had been on.
I then told them (my current specialist) that my prior specialist assured me that I definitely did NOT have narrow angle. My current specialist became somewhat testy and said I had to be mis-remembering or misunderstanding my previous specialist. They pooh poohed my concerns over the degree of my vision loss.
It's been almost 6 months now. My risk is that for me to know if the laser treatment was insufficient or is not working, my blind spots have to get worse. When that happens it is currently irreversible.
Though they all say it takes a long time for my vision to degrade, I know for certain that I had a major loss, particularly in my peripheral vision and just above my center of vision, that happened overnight or within a very few days. I suddenly couldn't see cars or people that were to my immediate left or some red traffic lights when I looked straight ahead.
If the last laser treatments were successful, I'm wondering whether the treatment was available years ago and could have prevented all my irreversible blind spots, had I been correctly and timely diagnosed. I doubt I will get a straight answer if I ask that question directly of my current specialist in a few weeks. So, I will only ask how long that laser operation has been available and hope I get a straight answer.
(c) 2013
I see said the blind man.
I suspect that eric-2573068 is purposely being contrarian, for any of many reasons and is NOT a real doctor.
With one exception (part of his message to ram-762581) no one could fit the bill of the close-minded doctor better. Too real to be real.
Thanks again eric-2573068. It's been fun. Then again...maybe not.
(c) 2013
nothing here but immature name calling
I bet you are a meek, weak individual in real life. But under the cloak of internet anonymity you are able to vicariously exact revenge against all who have wronged you
Sad, really
We had a specalist fly into Dallas from NYC. He spent one hour and said my brother's leg should come off. Brother said no way and made an issue of it. Our home town doctor spent hours studying the xrays and found unusual thing on his bone. Went in and took the object off his bone. Brother went back to school and played on the basketball team and never had a problem since. Of course the specalist from NYC got paid also.
Still, doctors are the best we have. I like the home town doctors that knows you since birth on delivering you. They seem to care about you more than the $ figure they can make.
Doctors need to go back to spending time learning "dis-eases" and not listening to the AMA and Drug Pushers.
Less than 50 years ago a pharmacist got your diagnosis, and knowing you and your problem, prescribed and formulated you drugs -- the mortar and pestal is their logo.
For 2 years I went in and out the revolving money door of allergy centers.
prick test....doc...pills....shots...prick test....doc....pills....I do shots....prick test.....doc....pills....F**K IT !!!!
Went to another doctor who did a blood allergy test on 150 foods and chemicals, somewhat expensive but insurance did pay
It came back one year ago and the problem----POTATOES !
Well I ate a very small amount 6 months on and sure enough the problems came back that night.
This is a challenge as potatoes and right behind corn as for being hidden in everything but it is worth the effort
Pay attention......BAD FOOD results in DOCTORS that results in DRUGS that cause problems and this repeats over and over.
The population needs to learn and fix the real problem..............
Welcome to the United Corporations and Churches of America [UCCA]
Where the real product is the stock and
The true customer is the stock holder.
In god we trust, all others pay foreign loan shark interest.
I wonder how much of this is 'if you hear hoof beats, think horses not zebras". Sometimes the doctor might not be listening, but if there are certain symptoms there are certain things that are more likely than others. The first step would be to diagnose the more likely disease unless there is reason to check otherwise. People always complain about excess testing. Diseases do get diagnosed, but I guess I don't see how something could truly be a misdiagnosis just because a doctor didn't leap to doing a lot of tests to catch the rare instance that something that's usually a common, treatable disease is something more serious.
There is a deeper issue not really addressed in this article, but underlying most if not all of the patient comments here, that is the fact that doctors don't have time to spend with their patients. The researchers say that doctors don't take the time to do a thorough workup - well, that's because a typical primary care doctor's visit is only 7-10 minutes because that's all they can afford to spend if they are going to pay their bills. Primary care is paid very poorly, so doctors have to see more patients to make up the difference. That's a guarantee that you are going to miss things and not have the time or patience to really listen to the patient, investigate thoroughly, and answer their questions. The solution? Direct Primary Care. This model eliminates the insurance based, fee for service payment system and allows doctors to work directly for their patients. At my company, Qliance (www.qliance.com), we have smaller numbers of patients to take care of, and we can take all the time we need to get them the care and attention they need. 30-60 minute office visits, phone visits, email, whatever it takes, and no limit to the number of contacts per month, it's all included in a flat monthly fee of about $65/mo. It's more than what most primary care doctors get paid per person now (typically $25/mo on average under typical insurance arrangements), but still not a lot, and allows us to give much better care since we aren't rushing to move on to the next patient.
For the contrarians in the group - I would urge you to listen to the angst and frustration in the voices of the people who have written here. Would you want to go into a doctor's office and be rushed through a visit and told to go away and come back later when they are good and ready to talk to you again? What if you had a serious concern, or just needed some time to get comfortable with the doctor so you could tell them what's really bothering you? The poor care and service in our system are all too real, there are way too many people who have had bad experiences for us to be complacent any longer.
For all of you who are patients - yes, I'm a doctor, and I'll tell you that most of us truly want to do a good job and take care of people in the right way, but the system is bad and drives bad behavior. We need to change the system so that there is a chance of doing the right thing. And the most important "right thing" we can offer is our time, our attention, our empathy, and our commitment to stand by our patients and keep trying to find the answers to what ails them. We can't always find a reason or a cure, but we certainly can treat each other like human beings.
I'm sorry but your comment "Primary care is paid very poorly, so doctors have to see more patients to make up the difference" is false. The average primary care physicians pay is $260,000 a year. It is simply greed that makes them pile on the patients.
If they can't make it as an independent business person, do what most others do...get a job with an organization that can manage it's business. Becoming a physician is the most sure way to riches. No other career offers this assurance.
@Guyfromsandiego
And how much do those doctors pay for malpractice insurance? Just because the average pay is 260K per yr, doesn't mean that their rich. Figure malpractice a 50K per yr, education bills, probably another 50K, and then their continuing education bills, probably another 5 to 10K per yr.
Right there is over 100K just for doing his work as a doctor. Then figure in the AMA dues, the local club dues, etc etc. He might, after all the necessary expense's, have a take home pay of around 100K per yr. That is a lot less that the big figure you put out there.
And no, it's not greed making them see that many patients, it's trying to see all the patients that have appointments. How would you like to be told to come back tomorrow because the Dr doesn't have time today to see you?
I do agree that some Dr's do get rich, but not all of them do. And you are wrong about other careers not offering this assurance. For one, think about dentists. I could name more careers, but you would likely scoff at them.
Where do you get this? It's simply not true. The average pay in 2011, based on 2010 data, was $189,000 for primary care physicians. After certain aspects of Obamacare went into effect, the average salary for primary care physicians was $212,000 according to 2011 data.
Also, the average PCP works 70 hours/week. So, with a 2 week vacation, at the $189,000/ year, the average PCP was earning $52/hour, with the increase, they are now averaging $58/hr.
Now, let's consider the amount of education physicians have - 4 years of undergrad, 4 years of medical school and 3+ years of residency (during residency they do earn about $40,000 - $56,000/year for the 1st year - depending on location and specialty, with primary care physcians earning toward the lower end of that), at minimum. Many physicians also have a Master's Degree and/or a PhD (in the case of a Master's Degree, this is often earned between undergrad and medical school). So, there is often a lot of student loan debt.
Then, of course, there is malpractice and other costs of being a phsycian (such as CME's, Board certification exams, etc., etc.)
Didn't have time to add - no, being a physician is NOT the most assured way to become wealthy.
If you think a medical career is the path to riches then why don't you become a doctor?
As a practicing primary care MD, I find many of these comments and the suggestions of this study revealing about the assumptions and misconceptions about modern medicine. As much as people believe that making accurate diagnoses is easy--because Dr. House and Gray's Anatomy docs do it, flawlessly every week--it is not true and not always so easy. Medicine has evolved and advanced greatly in just the last 30yrs and we laugh at some of the treatments even from the 1970s and 1980s, but the reality is there are no perfect medicines, treatments or pills or diagnostic tests for whatever that ails you. I agree that some doctors are arrogant and resistant to using information technology to improve their care. If your doctor is not working in front of you with a computer then he is practicing antiquated medicine like the 70 and 80's. I use up to date internet medical programs and medicine interaction and prescribing programs during every encounter. There are new drug interactions being found every week and no human could possibly know all this without using a computer database. I do not have to take recertification exams because I received my board certification prior to this requirement--and frankly do not need to because of my constant use of information technology, I am always up to date. Even with this arsenal of information, it is not always easy to make an accurate diagnosis on 1 visit. If your doctor does not try to answer your questions and is not using the computer and drug prescribing programs as an active part of their practice--get a new doc who does. I am over 50 and there is no excuse because of age or arrogance not to use the information technology that was not available in the past.
I do think most doctors want to help people. I also think that most PCPs have too many appointments and a, perhaps somewhat reasonable, distrust of patient accounts of symptoms. I've never had any serious health issues, but have had problems with minor issues. I once developed folliculitis after being on an antibiotic and had multiple doctors (I went to Planned Parenthood due to the location of the folliculitis) try to prescribe me antibiotics to take care of the folliculitus. It was very frustrating to have to argue that I really didn't believe the rash was bacterial because I developed it while on Bactrim. Finally a doctor gave me Diflucan, but that didn't help either and subsequently the same doctor told me to just keep the area clean and dry and the rash would go away. About 3 months later when the rash was a red hot mess that hurt like hell (and was spreading everywhere) I went to google and found that folliculitus can be fungal and I tried using the treatment from ehow (simple anti-fungal cream). What do you know, it worked! Sad I had about 5 doctors appointments (sooo expensive) and ended up having to help myself.
I don't think the doctors were being arrogant, I think they were short on time and that doctors are used to not trusting patients. They didn't trust that the rash developed while on Bactrim or that the rash was getting progressively worse. I assume there are quite a few patients who do provide bad information for whatever reason, but it was frustrating to feel like the doctor didn't believe me. The experience did make me skeptical of doctors.
I'm sorry to say you are typical of some people with limited medical knowledge--not to say you are not bright --but you are not a doctor and most doctors would doubt the accuracy of your diagnosis. I would have to see this rash to really be sure. It may be what is being described as folliculitis is actually something else. Folliculitis would be limited to the hair follicules and though this is possible from bactrim it is unlikely to last 3months after you stop it. A fungal rash could be precipated by being on an antibiotic (not just bactrim) by its affects on the normal bacterial flora of you skin, but this would not be considered some kind of allergic reaction. You could have had a fungal rash, tinea corporis and scratched and irritated the underlying hair follicles and gave the appearance of a folliculitis. If this rash was limited to a small area. it again would not be consistent with a typical drug rash. You could have had a fungal skin rash that has nothing to do with having taken bactrim which is what most of those doctors would have likely concluded.
agreed. this is the trouble with the internet...everyone's an expert