I saw Dr. S for an enlarging and pulsatile swelling on my right index finger. The Nurse Practitioner at my GP's office had examined the swelling and said she thought it might be a venous ectasia, or AVM. She said I should ask Dr. S about this possibility. My brother, an anesthesiologist, also examined it and, with no knowledge of the NP's assessment, said the same. He noted that there were red spots on my skin near the swelling and said they were telangiectasias, which, combined with the strong pulse, made him more certain this was some sort of vascular malformation. I saw Dr. S and he said it was most likely a cyst, but that he would not know for sure until the excision was done. When I asked him about the possibility of the AVM he said, "This is why I don't like talking to people who don't know what they are talking about. That is a stupid question." He went on to say he had not seen that in 25 years, and used the old hoof beats/horse/zebra aphorism. He did back off a bit, and say he… could be surprised, but it would be the first time in 25 years. When I asked him about the spots on the skin he did not look at them and said, "You are talking to the wrong doctor, I'm not a dermatologist." Despite this, I pressed him a bit further and asked if he did not, then, believe they were related to the swelling. He still did not look at them, and said, "No." Three days prior to the surgery, I dried my hands and one of the telangiectasias began bleeding rather profusely. The blood soaked through three Band-Aids before it stopped about 15 minutes later. My brother told me to be sure to let Dr. S know prior to the surgery, as this made my brother more certain that this was a vascular issue, not a cyst. When I saw Dr. S in the surgery center immediately prior to surgery, I told him about the bleeding incident. He said, "That's weird. Well, I'm not doing anything there, my incision will be hereâ??, and he indicated the other side of my finger. After surgery, while I was still in recovery, my husband was in the waiting room and happened to look out the window and saw Dr. S walking to his car. My husband ran out into the parking lot and stopped him to ask how the surgery went. My husband reported that the Dr. said the surgery went fine, and it was NOT a cyst. He told my husband to tell me to bend the finger. There were no other after care instructions given. If my husband had not chased him in the parking lot, the doctor would not have spoken to either of us after the surgery that day. When I saw him one week after the surgery he spent perhaps three minutes with me. A tech removed the stitches, and Dr. S told me he had to leave as he was due in surgery. He said it was not a cyst, and was perhaps a hemangioma, especially, he said, given the bleeding I had reported (which came from the spots on my hand he said were not related to the swelling). He told me that the pathology report was not in yet, and I would need to come back the next week if I wanted to â??talk about itâ??. He left. I told the office assistant that I wanted the pathology report and the operative notes faxed to me as soon as they were ready, as I could not come back the following Wednesday due to work commitments, and Dr. S is only in that office on Wednesdays. I did want the opportunity to â??talk about itâ??, however, so I made an appointment for two weeks later. In the meantime, the path report and operative notes came in. The diagnosis on the path report was â??hemangiomaâ??. The operative notes were notable only in that they described, in three separate places, the diagnosis of and procedure done to my LEFT index finger. The lesion was on my RIGHT hand, and the surgery was performed on my RIGHT index finger. At any rate, I had several questions based on my own research and my conversations with my doctor brother. When I went in for my appointment, I waited over an hour to be seen. When I went into the exam room, Dr. S came in and said â??Letâ??s have a lookâ??. He looked at it and told me the hemangioma diagnosis, and that the incision looked good and would be red for a while. I asked him if there was any known etiology of hemangioma and he said â??Why do people get cancer? Iâ??m a hand surgeon, not a doctor.â?? He told me that the hemangioma may come back, or may not, and to call them if it did, and he got up and headed out the door. Since I still had questions I continued to address him as I followed him to the counter where he had the office assistant make me a copy of the pathology report. I asked him about one of the tests that had been run, and he said, â??Talk to a pathologist, I donâ??t know what they do.â?? He then turned and began to open the door to the next exam room, and I told him about the operative report error. He said he would fix it and went into the room and closed the door. After waiting over an hour for the opportunity to â??talk about itâ??, I felt very dissatisfied, and my questions were unasked and unanswered. In my opinion the unwillingness to consider and address questions raised by other health professionals, if not by the patient him or herself, and the lack of attention to anything other than the very narrow area he would be excising, could conceivably lead to mismanagement of a patientâ??s issue. In my case, hopefully, no adverse development has occurred, but as several of my questions remain unanswered, I donâ??t really know. I will be seeking a referral to someone who will allow me to ask the questions I still have regarding the original condition, and the recovery of my hand, and who will do their best to answer my questions. I will not be returning to Dr. S for any reason.
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