Self-Fulfilling Diagnoses

A young lady 23 years of age, recently reported to her orthopedic surgeon complaining of pain in the right hip. Because it was summertime and warm, she wore shorts to the appointment. An obvious rash could be seen in the area where there was pain. An X-ray revealed no contributing factors. The surgeon prescribed physical therapy, with the comment that if the pain did not resolve, an MRI would be ordered.

Four days later, the pain had intensified to the degree that the patient fainted at work and was sent to the ER. An extensive work-up including MRI and ultrasound took all day, yet there was no diagnosis made by the team of ER physicians. The patient was sent home with a prescription for analgesics, and advised to wait.

The next day, “D” walked into a local clinic because the discomfort associated with the rash persisted and she hoped that at least this condition could be treated. The primary care physician on call took one look and immediately diagnosed herpes zoster. The diagnosis explained the symptoms: pain, rash, and itch. Unfortunately, the diagnosis was made too late for an effective course of antivirals and “D” continued to suffer for another few weeks although the pain and itch steadily diminished in severity.