seeking a second opinion

[kaysixteen]

I have an ongoing skin condition on my legs, an annoyance and unsightly but not dangerous, but I think it may be evolving.   I have not seen my dermatologist since late '21, largely because the disease had been stable for many years and she really did (and needed to do) essentially nothing other than refill the meds (cremes), which are used as needed, but since she would only give a pair of refills per visit, she was more or less dragging me back regularly to get the refills.   Then I asked my PCP to add these meds to my regular meds he has prescribed, and this obviated the need to see dermo if only regular refills were needed.   But as I said, disease is clearly evolving, and there may be signs of the same sort of skin infection that I had that originally necessitated dermatological intervention in 2014.  (the disease I have is separate, but does make me susceptible to potential infections).  This doc is older (probably about 63-5), and while adequate, did greatly misdiagnose an internal cellulitis bout I had in 2018, requiring a week of hospitalization (she did not biopsy the infection and guessed wrong-- my PCP correctly diagnosed the issue over the phone when talking with her a week later and ordered my immediate hospitalization).  Derma practice is also 45 minutes away, and, quite frankly, it is the haughtiest, snobbiest, and most irritating med practice I have ever encountered, for a variety of reasons.   So since my legs do now seem to be in need of additional dermatological attention, and there are numerous dermas practicing in my own city, I have decided to get a second opinion here, rather than returning to my current one.   My question is thus, what to tell the doctor when I see hu for first time-- I do not want to prejudice the doc, and want hus honest opinion?   I have never sought a second med opinion of any kind, from a different practice, before.

[hmaria1609]

You write there are more dermatologists in your city--that's great! Ask family, friends, or colleagues for recommendations of what practice they go. When you go in for your appointment, refrain from telling the opinion of your current dermatologist. Then you can go from there. Hope this helps!

[Hegemony]

I agree. Don't tell the current diagnosis until the new doc makes their own diagnosis. It's good that you have a number of options — wishing you a great doc and much success.

[Kron3007]

I have an ongoing skin condition on my legs, an annoyance and unsightly but not dangerous, but I think it may be evolving.   I have not seen my dermatologist since late '21, largely because the disease had been stable for many years and she really did (and needed to do) essentially nothing other than refill the meds (cremes), which are used as needed, but since she would only give a pair of refills per visit, she was more or less dragging me back regularly to get the refills.   Then I asked my PCP to add these meds to my regular meds he has prescribed, and this obviated the need to see dermo if only regular refills were needed.   But as I said, disease is clearly evolving, and there may be signs of the same sort of skin infection that I had that originally necessitated dermatological intervention in 2014.  (the disease I have is separate, but does make me susceptible to potential infections).  This doc is older (probably about 63-5), and while adequate, did greatly misdiagnose an internal cellulitis bout I had in 2018, requiring a week of hospitalization (she did not biopsy the infection and guessed wrong-- my PCP correctly diagnosed the issue over the phone when talking with her a week later and ordered my immediate hospitalization).  Derma practice is also 45 minutes away, and, quite frankly, it is the haughtiest, snobbiest, and most irritating med practice I have ever encountered, for a variety of reasons.   So since my legs do now seem to be in need of additional dermatological attention, and there are numerous dermas practicing in my own city, I have decided to get a second opinion here, rather than returning to my current one.   My question is thus, what to tell the doctor when I see hu for first time-- I do not want to prejudice the doc, and want hus honest opinion?   I have never sought a second med opinion of any kind, from a different practice, before.

If the new dermatologists are in your city, I would likely just tell them that the other was too far and you are trying to find a closer doctor to take over now that it is progressing. 

Doctors don't tend to be too chatty, I doubt they will ask any further questions.

[kaysixteen]

Ok, that was my thinking too, but when/if New Doc says this is 'disease a', when Old Doc has long said it was 'disease b', should I not then tell New Doc what Old Doc thinks?

[Langue_doc]

Ok, that was my thinking too, but when/if New Doc says this is 'disease a', when Old Doc has long said it was 'disease b', should I not then tell New Doc what Old Doc thinks?

No, all you need is a second opinion. No need to tell the doctor about the previous doctor's diagnosis. Doctors usually don't have time to chitchat but want to know why you are seeing them, what your symptoms are, and what you have been doing to alleviate the symptoms. If pressed for a reason, which is most unlikely, you could mention that your PCP is concerned that the current treatment hasn't produced any tangible results.

As for conflicting diagnoses, you could discuss them with your PCP. Telling Dr. B about Dr. A's diagnosis would be analogous to students telling Professor A that Professor B does things differently.

[Hegemony]

I would want to know why Dr. A says one thing and Dr. B says another thing. If Dr. A says it's gobular dermanoma (I am making that up, obviously), and Dr. B says it's particulitis, at the least I'd ask Dr. B something like, "I was wondering/Some people have suggested that it's gobular dermanoma. What would you say rules that out in favor of particulitis?" It would be useful to know if Dr. A says, "Hmm, gobular dermanoma would be my second guess, but I'd say the bumps weigh in favor of particulitis," vs. "Particulitis! Never! That always produces big purple spots, which you clearly don't have."

[Wahoo Redux]

The new doc will want to see your medical records at some point, so you might get those ready.

I hope the new office works out for you.

[apl68]

I would want to know why Dr. A says one thing and Dr. B says another thing. If Dr. A says it's gobular dermanoma (I am making that up, obviously), and Dr. B says it's particulitis, at the least I'd ask Dr. B something like, "I was wondering/Some people have suggested that it's gobular dermanoma. What would you say rules that out in favor of particulitis?" It would be useful to know if Dr. A says, "Hmm, gobular dermanoma would be my second guess, but I'd say the bumps weigh in favor of particulitis," vs. "Particulitis! Never! That always produces big purple spots, which you clearly don't have."

Even as a layperson, I'd be embarrassed at mistaking simple particulitis for gobular dermanoma.  I mean, come on!


But seriously, Kay--I hope and pray you're able to get some relief from this problem soon.

[kaysixteen]

I did make an appt yesterday with a local practice here, the derma practice being just one of various subspecialties this large outfit has in this area, where it appears to be the gold standard.   Indeed, my urologist is also part of it.  It will be in three weeks, but I am looking forward to  it.  This leg condition is something that does need to be addressed.

[latertater]

I suffered mightily with a rash and pustules on my arms and legs for about three years; it occurred after a trip to Louisiana in the summer. The PCP did not know what to do about it.  I would definitely find a good specialist.  Dermatologists vary wildly; they are always booked very far out (because they like to talk, one physician said).

It subsided over the winter and I returned from a conference trip with a terrible itch on my limbs, and the derm prescribed a topical insecticide and it went away after that.  I hope you have some remedies soon.

[Wahoo Redux]

I did make an appt yesterday with a local practice here, the derma practice being just one of various subspecialties this large outfit has in this area, where it appears to be the gold standard.   Indeed, my urologist is also part of it.  It will be in three weeks, but I am looking forward to  it.  This leg condition is something that does need to be addressed.

Hope it works out, buddy.