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Sunday, 30 July 2017

My doctor(s) can't seem to help me. What should I do?

I have a serious skin problem. I have a red swelling on my cheek which started as a "pimple" but gradually getting larger. I had taken a few courses of antibiotics in the past one year, including a 6 months course of erythromycin from my family doctor. He took a small skin sample from my cheek prior to the long course of antibiotics but the report wasn't conclusive. Then I was given oral steroids which seems to get the swelling slightly smaller but it never goes away. I trusted my family doctor as my family has been under his care for years. But he can't seem to solve my problem. What should I do?

Here's what I think you should consider.

1. What is the diagnosis? Sounds like no definite diagnosis has been made so far. Effective treatments often comes from an accurate diagnosis. (Yes, I say "often", some people treat by hunches, and it works, sometimes. But the basic of medicine should be diagnosis first before treatment.)

2. How was the skin sample taken? Was it taken at the right place? Was it deep enough? Is the cut big enough for the laboratory to examine? What laboratory tests have been done? A histopathological examination? Any extra stain needed? What about culture for fungus and bacteria and other not so common bacteria?

3. Perhaps you might want to politely ask your family doctor if he thinks any other doctors or nearby dermatologists may help you with your problem? Most if not all good doctors do not mind writing you a letter, giving out your previous investigation and biopsy records. If a particular doctor is very defensive about you going for a second opinion, it may be, well, a warning sign perhaps.

4. Consider going to dermatologists in bigger or more well known medical centres because they may be more experienced in managing not-so-common skin problems.
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