(April, 1999)

Firing a Healthcare Provider and "Rosacea"
from Sherry S.

Great to read your March Briefing, Ed [Ed Note: Sheri sent me the article about the discovery of antibacterial peptides in psoriatic scales]. I have been so involved with my latest medical skirmish that I hadn't checked Flake HQ at the beginning of the month.

I fired my optometrist of ten years by letter today because of his misdiagnosis last Friday afternoon of "scleritis and/or uveitis," conditions, which I found from reading the Merck Manual, require immediate ophthalmologic referral, which, of course, he didn't do, going off to ski for the weekend and not returning to his office until the following Wednesday. Meanwhile, he had done an extended dilation of my eyes, such that seeing the refrigerator light made me squint, even through sunglasses and that insert they give you after your eyes are dilated. The dilation lasted through Monday. The ER referred me to an opththalmologist. Scleritis and uveitis, incidentally, can result in loss of the eye.

The ophthalmologist I saw Monday, and again yesterday, took me off all the eye drops the optometrist and ER had inflicted on me (Gentak/TobraDex/Cortisporin). He said I didn't have scleritis or uveitis (yipeee!). He asked if I might have rosacea, since there are ocular effects, and I said my derm had said NO when I had asked him. I have some of the symptoms: flushing when exercising that doesn't go away for the rest of the day, a pink face when the temperature gets much above 75F, and now, a sort of permanent cheek blush. Several people have asked me if I have rosacea. Today I heard from two women friends that this same dermatologist (mine of the past 10 years) did not diagnose their rosacea. Since there is no blood test, maybe they don't have it. WHO KNOWS! I am getting mighty "sick" of the lack of definitive answers from the medical profession. Meanwhile the P just keeps on a-keepin' on.

Ooops. How did this get to be such a rant?

How's by you, anyway? -Sherry S.

*****

Ed's Response: Sorry circumstances forced you to fire you optometrist, Sheri, but in your reasons why lies a good lesson for all of us. Healthcare providers of all flavors, in this country at least, are, I think, facing a rising tide of patient awareness. It's becoming easier for us to learn a little bit independent of what the docs and medical care givers (like optometrists) tell us. The Internet is a catalyst to this, but by no means the whole engine of change. Economics is motivating some of this new level of patient empowerment. We can all remember the national focus on the unchecked increases in the cost of health care during Clinton's first two years as President. It was (you will recall) the reason behind most of those "Who's-running-the-country? Bill or Hillary?" jokes (because Hillary was so visible in the healthcare reform initiative). I think most lay observers would tell you the attempt at reform through government stalled, but in the process mass attitude about health care turned a bit bitter and the result has been less casual acceptance of medical authority. And that attitude is bulwarked by the work of thousands of related non-profit watch-dog organizations, the continued coverage of abuses by media, fear and its consequences in the health insurance and pharmaceutical industries, and the degree to which all of us can raise our levels of informed consumerism—in part, through tools like the Internet.

I'm at that age where the generation behind me has, during this decade, made their first—and they believe, for the most part, their final—career decisions. None of my children, nephews or nieces opted for medicine as a career, but I was ready with some comments had any of them asked my opinion. Three decades ago, when I faced this decision, we didn't ask ourselves, "Would I find a career in medicine rewarding?" No, the prevailing question was, "Could I survive medical school?" Or, put another way, "Am I willing to work that hard to pass muster?" We assumed we would enjoy the rewards if we could survive the rites of passage. ASIDE: I think we were a little bit buffaloed by the rite of passage as I had a number of acquaintances my age who are, now, practicing health care professionals, few of whom struck me, beforehand, as being intellectually equipped to succeed. And today I'm afraid my tendency would be to avoid falling under their care as much as I would avoid the plague. One of these failed to get admitted to any medical school in this country, so went to Mexico to earn his M.D. What does that tell you? END OF ASIDE. Anyway ... The opinion I was prepared to share, had I been asked, was, "Do not believe you will always be a doctor (or whatever in healthcare). Do not put all your eggs in one basket. Do not declare you are preMed as a Junior. Study anything else, first; get a masters in some other field, second; then become a doc if the ambition still consumes you." By the way, I was prepared to give the same advice to any youngster who approached me about their prospects as a lawyer. And to any who professed interest in obtaining an MBA, I was going to say: "You will always find employment as a cab driver in Vail, Colorado; or as a holiday temp at the U.S. Postal Service." (Do you suppose all the youngsters avoided approaching me about these career issues because my attitudes were too transparent?)

Your discussion of rosacea sent me scampering to the Internet, Sherry. I learned that it's pronounced rose-AY-shah, that there is no cure, and it was the condition which gave W. C. Fields his trademark bulbous nose. After checking out the web site ... http://www.rosacea.org ... I became convinced that I have known many people with the affliction. Now I wonder if they knew about rosacea. Like P, it's incurable and not well understood. It isn't life threatening; mostly embarrassing. Socially, the uninformed too often translate the symptoms as alcohol-induced (that's what they thought caused W. C. Field's permanent flush and bulbous nose). At its worst, it causes pimples and pustules often confused with adult acne, but more typically it just causes that "lingering flush" you mentioned. Once diagnosed, there are several methods of control that include some topical medications, some systemic meds, and recommended life-style changes (principally, avoiding situations that make you flush). It would be unfortunate for flakers to also suffer from rosacea, because flushing caused by exposure to sunlight is not good for the rosacea and, as we all know, sun exposure is GOOD FOR many flakers. So, I'm glad to hear you have not been diagnosed with rosacea and hope that doesn't change.

Stay cool, Sherry! -Ed

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