A Concurring Second Opinion

My senior colleague, Dr. Wilford Brown, was waiting for me at the nurse’s station yesterday with a funny look on his face.

“Oh, Esteemed Colleague” he started, cleared his throat, and continued:
“May I bother you for a second opinion and reassurance for this patient that two capsules of doxycycline is more than adequate to protect her from Lyme disease?”

I glanced at the chart he was holding in his hand. It belonged to Laura Leonard, a very ladylike woman with a tendency to worry about bad diseases.

I agreed, and we entered her exam room together.

Mrs. Leonard showed me her ankles, which were covered with small, red dots of an unmistakeable nature: Flea bites. She preferred to think of them as tick bites, because some of them had a slight red ring around them. ” I know these are not flea bites”, she stated very firmly as I kneeled down to examine her ankles.

I explained that I grew up and trained in Sweden near where Arvid Afzelius first described Erythema Chronicum Migrans in 1909, the rash that later came to be associated with Lyme disease.

“I agree with Dr. Brown”, I said. “This is a low risk situation.” He glanced at me from the corner of the room.

“Between the appearance of these spots and the two doxycycline capsules, you can be quite sure you won’t develop Lyme disease”, I said.

She thanked me profusely, then she turned to Dr. Brown and thanked him, too, with the comment: “I didn’t question your judgement or anything…”

He looked her squarely in the eyes and answered in a serious voice but with that funny little look on his face again:

“Oh, I won’t lose any sleep over it!”

I’m sure he didn’t, either.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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