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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Dr. Zorba Paster: Doctor’s judgment as meaningful as medical test

Dr. Zorba Paster

Dear Dr. Z: I was aghast at the response on your radio show to the New York City caller, the dad whose young daughter had ringworm. Your response was typical of a lot of doctors: Why not jump into treating it without knowing what’s really going on?

You said it looked like ringworm, which is a fungal infection. But is “looking like” good enough? Nope, it isn’t. You should know that.

You should have told him to see a doctor and have a KOH test (a procedure that uses potassium hydroxide) to see if it’s really ringworm. Maybe that child had Lyme disease. If so, by not treating it you might have given her a life of misery.

I have chronic Lyme disease. It’s awful. You should act like a doctor and get that diagnosis straight. Don’t just dispense from the hip. – S.G. from Wisconsin

Dear S.G.: Thanks so much for taking the time to write this letter. I look at all complaints as manna from heaven. I think for every one complaint there are probably 10 out there, with most people not taking the time or finding the energy to write like you did.

So let’s start with the diagnosis. First off, New York City and Lyme disease don’t exactly go hand in hand like they do in Wisconsin. Next, the caller’s description of his daughter’s rash sounded more like the rash of ringworm and not the rash of Lyme disease. Search Google images for each and you’ll see what I mean.

Now, if you add up the cost of a doctor’s visit, a KOH test and a Lyme disease test, you’re probably at the $250 range or higher – NYC prices are steeper than those in the Midwest. Generic antifungal cream, which is what I recommended, comes in at less than $10. That’s quite a cost savings.

I have written in the past about too much unnecessary medical testing that continues to fuel the rise in health care premiums. This is one example.

And finally, let’s talk about clinical judgment vs. laboratory testing. We have come to a point in medicine where many of us have stopped using clinical judgment. We think we always need some technology to confirm what we know, even though we have been trained to see it.

Do I really need to order a test for every rash I see to rule in or rule out a diagnosis? I don’t think so. That’s when it comes to dispensing advice in my office.

Of course, when it comes to my radio show, TV appearances, medical column or even my book, that’s a different issue. We always mention, sometime in the column or on the air, that this is not the same as the medical advice you may get from your health care professional. Most people know that.

My spin: It’s important to test when you need to do so, and not test when you don’t. A good clinician, doctor, physician’s assistant or nurse practitioner can often give you a proper diagnosis without testing. If you trust them then you might trust their judgment. Stay well.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “ZorbaPaster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column appears twice a month in The Spokesman-Review. He can be reached at askzorba@ doctorzorba.com.