I do appreciate the answers to my original post
on this soft tissue mass. The patient is
extremely hard to deal with and has yet to
follow up on the repeat MRI with contrast as
recommended. At his last visit he feels that
the tumor is a result of trauma from kicking
against the side of the pool when making turns.
I have tried to express the importance of
identifying and treating this soft tissue mass
and hope he will follow up with the MRI. I am a
little disturbed though when advice is given
stating that if you have to ask the question on
PM News then you probably aren’t the best person
to handle the patient and refer him to someone
else. I feel that this is a terrible answer.
Should this be our standard answer now when a
clinical question is asked on this forum?
I pride myself on always putting the patient
first and never getting in over my head. I feel
that I am exceeding the standard of care with
this patient and trying to get all opinions
prior to moving forward. I will absolutely refer
this patient if and when I need to. I still
don’t have all the answers I can get and until I
can prove to the patient that this may indeed be
a very serious matter, he isn’t going to
another “expert.”
I’m having a hard enough time convincing him
that the repeat MRI is needed even when I
managed to call the MRI center and get it for
free since they “missed it” the first time.
I hope others that ask for treatment opinions on
this forum don’t have to be talked down to by
our own experts when asking questions so we can
provide the best care to all of our patients. I
always appreciate Dr. Markinson’s advice and his
knowledge is 2nd to none when it comes to topics
like this, however I feel that telling all
podiatrists (or even doctors in general) to send
the patient to someone who knows more is not the
right answer.
Answer the question asked if you have knowledge
on the subject and as pointed out in your first
reply I can send this patient to someone else if
I don’t feel comfortable performing the
recommended treatment. I feel that a great
benefit to this forum is the ability to ask
questions to our professions experts and get
more information to help us manage patients
better. I am also not so egotistical and/ or
naïve to think that I can treat / handle
everything. But my best asset as a doctor is
knowing what I can do and when I can’t knowing
who is better than me for the job. So I
understand the advice you gave, however I feel
that the way you put it discourages the open
forum we have here and may limit further
questions since the response may be “I am
positive that the patient could be in better
hands.”
If I can get the patient to come back in with
MRI. I will try to post pictures of the mass as
well as MRI images if I am able to. This is my
first line of treatment is to obtain better
imaging and if radiology suggests malignancy
then an oncology consult to plan for treatment.
Robert Lagman, DPM, Covington, LA,
rlagman@drlagman.com
