“So tell me why you’re here.” 

The speaker was the dermatologist, Dr. Chung, at the Penn Dermatology Clinic at the Perelman Center for Advanced Medicine all the way over on Civic Center Blvd.

“Well,” I said, “my regular dermatologist, Dr. Crawford, noticed the redness on my upper arms, and while he had previously diagnosed that as eczema, he decided take a biopsy. He called me a few days later and said that the biopsy showed that there were abnormal cells and possibly lymphoma but not the scary kind, or at least I shouldn’t be scared. He used the initials CTCL and suggested that I make an appointment at this clinic. So that’s what I did.” 

“Yes,” she said. “I have the results of that biopsy here along with his notes.”

So why did she ask me why I’m here, I wondered. Probably to double check that I’m the patient described in her notes. It has happened already that a doctor has picked up the wrong patient’s record and had to go and get the correct one.

Actually, things were a bit more complicated than I had let on. During my visit with Dr. Crawford, I was initially seen by a new PA, and she remained when the doctor himself stepped in. After the doctor checked me over, the PA pointed out the redness on my arms, and there was some discussion. I said that the doctor had diagnosed it as eczema and I’ve been treating it with a steroid cream and a moisturizer. Is it itchy, they asked. No, I replied. The doctor seemed satisfied but the PA wasn’t.

“Oh, I know what you’re thinking,” said the doctor to the PA. They entered into a hushed discussion and it seemed like the PA would not let the matter drop. Finally, the doctor said he would take a biopsy. It almost seemed like he was doing it just to prove to her that the results would be negative. At least I expected the results to be negative, so I was surprised when they were not.

Well, Dr. Chung took two more biopsies, one from each upper arm, and while Dr. Crawford’s biopsy was so tiny it barely left a mark, Dr. Chung’s were each nearly the size of a dime, and she warned me they would leave scars.

They did, in fact, leave scars.

Dr. Chung called me two weeks later (this appointment took place in June) with the results. The biopsies were negative. The redness was eczema after all, just as Dr. Crawford had originally diagnosed it.

But here’s the thing. 

The treatment for both eczema and CTCL lymphoma is exactly the same. That is, apply the topical steroid Clobetasol Propionate on an as needed basis. And CTCL lymphoma is apparently not even life threatening. So if I had CTCL lymphoma instead of eczema, it wouldn’t have made much difference one way or the other. The treatment is the same.

So why did I have to spend several hours going to the other side of the city, get additional tests, biopsies that leave permanent scars, just to find out whether I had something that was not life threatening and for which I was already receiving the proper treatment anyway?

Now I realize that there are many, many people who have to go through much worse medical procedures than I did, so I don’t want to come off as complaining too loudly. After all, I don’t have any life threatening conditions, I don’t have to suffer through chemotherapy or dialysis or anything like that.

So I realize that the inconvenience that I went through is extremely small potatoes in the grand scheme of things.

I’ll be going to see Dr. Crawford for a followup appointment this week, and presumably the PA will be there as well. I can understand how perhaps the PA, especially if she is relatively new on the job, might make a mistake, but isn’t it the doctor’s responsibility to take charge? I don’t understand why he allowed her to override his longstanding and correct diagnosis.

Actually it was a bit worse than that. The PA claimed that the topical steroid Clobetasol Propionate, which Dr. Crawford had prescribed for the eczema, was too strong to use on my arms, and she refused to renew my prescription, something I didn’t realize until a few days later when I discovered that the pharmacy had not received an updated prescription.

I have to admit, though, that part of the blame falls on me. Because the eczema was only making my upper arms appear a bit reddish, and I was not feeling any itchiness, I wasn’t using the topical steroid as much as I might have been.

So the arms are a bit red? Why should I care?

Had I been more diligent, there might not have been any redness for the PA to see. But I probably still would have had the problem with her not renewing the prescription.

Anyway, when I go in for the followup, I’ll have some questions that I want answered. And I’ll be able to point to Dr. Chung’s recommendation of Clobetasol Propionate as a treatment for both eczema and CTCL. I’d love to rub the PA’s nose in that. 

Metaphorically, of course.