THE LAST WORD

How a Doctor Acting as His Primary Care Physician, With a Little Luck, Tracked Down His Own Cancer

 

It started with a cough.

Fam Pract Manag. 2017 May-June;24(3):41-42.

Author disclosure: no relevant financial affiliations disclosed.

It started innocently enough with a cough. He assumed one of his patients gave it to him, although he always makes his coughers wear a mask. So he masked himself and made his patients mask as well when he coughed. He should have stayed home, but he had no back-up and didn't feel particularly sick. He had no fever and produced no sputum, so he presumed it was viral and took no antibiotics, but he brought his “bag of symptomatic treatments” to work, including aspirin, a cough suppressant, an expectorant, an antihistamine, and a decongestant. The cough persisted – two, four, then six weeks – and the bag grew bigger, but eventually it subsided. On a whim, he decided to get a chest X-ray to see if he had residuals of pneumonia. His wife said that was a bad idea (she disparaged medical tests because they often led to more tests and unnecessary procedures). Overriding her veto, he got an X-ray and thought it looked normal, but Russ, the radiologist, spotted a small area of pleural thickening. “Could be post-infectious. Have you ever been exposed to asbestos?” Russ asked.

“Insulated my house and barn in the 80s, but otherwise no,” he said.

“Then you'll probably need a chest CT and a biopsy. I can do that under CT guidance,” said Russ.

Great, he thought, I should have listened to my wife. “How about I take antibiotics first and see if it goes away?”

“You're the doctor,” Russ said.

About that time, he noted the emergence of a new symptom – a minor ache in his left testicle. He had diagnosed his share of orchitis and epididymitis in his career, but neither his testicle nor his epididymis was tender or swollen. He wondered what else it could be. Then he had an idea that probably would have been nixed by a proper primary care physician: Why don't I take an antibiotic that covers the lungs and the testes? He settled on levofloxacin, 500 mg per day for 14 days. He at least had the smarts to run it by his urologist in a neighboring town. Ruing

About the Author

Dr. Brown is a solo family physician living in Mendocino, Calif., and a long-time contributor to Family Practice Management. His “Practice Diary” ran in FPM from 1999 to 2005.

Author disclosure: no relevant financial affiliations disclosed.

Editor's note: Read more of Dr. Brown's story in “Keeping Your Practice Going When You Can't,” FPM, May/June 2017, and “The Key to Getting Through Chemo,” FPM, July/August 2017.

 

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