The Blue Ear Blues

[Ducked]

...got my hearing to lose
got diagnoses to choose
I got the blue ear blues

Cancelled class and went to hospital.

"You've got a fungal infection" ses they. (There were two of them. Professor Lee and Dr Lee , the latter probably an intern under instruction.)

"Could be a fungal infection" ses I, "but the literature suggests its more likely to be Pseudomonas aeruginosa, because its the more common cause of ear infection, because it smells, and because its blue."

"It isn't blue, its green", ses they, showing me a swab which did look more green than blue "so its a fungus" (Pulling out the BIG, diagnostic GUNS).

"It was blue yesterday" ses I. They look sceptical.

I continue "The literature describes Pseudomonas aeruginosa pus as blue or blue-green, and makes it clear that the colour varies with the strain and the environment."

(I LOVE how the internet makes it so easy to be a killer Dr Kildare smartarse)

I plough on "The Dr Lee who referred me here said it was probably bacterial"

(They look professionally non-comittal, since the Dr Lee Clan are supposed to stick together)

"He suggested that I get a swab taken for microbial identification" ses I. "How about doing that?"

(I have a lot more faith in medical technicians than I have in medical practitioners)

"We don't usually have to do that" ses they.

(Likely no one asks them to, there's a delay and cost involved, and it detracts from the omnipotence a bit.)

(I think I'm starting to piss them off.)

"If we don't have positive identification perhaps we should assume its both bacterial and fungal. Could you treat for both?" ses I.

(I forgot to say "not only ...but also". I have learned NOTHING)

"Yes, we could give you not only antibacterial but also antifungal ear drops" ses they, brightening a bit.

(Dr Lee's LIKE prescribing)

"The other Dr Lee prescribed oral Dicloxacillin, a modified penicillin. This won't be effective against Pseudomonas or a fungus." ses I. (reference to the literature here would probably have been overdoing it a bit)

"Should I stop taking this antibiotic?"

"Yes, the ear drops are more likely to be effective" ses they.

(Not sure about this. Though the Dicloxacillin was probably mis-prescribed, stopping a systemic antibiotic course part-way is probably a bad thing, and there MIGHT be another bug involved against which it would be effective. Perhaps dissing it saved the 2-New-Lee's face a bit, but OTOH if it is fungal a penicillin is quite likely to encourage it.)

I should probably have insisted on microbial identification. AND I have to check the stuff the 2-New-Lee's prescribed for gotcha's.

Its a hard life, medical consultancy.

And badly underpaid.

[grandfeller]

Great narration, Ducked. There certainly are good physicians here, but there seems to be a wide variance as well.

Coming from Scottish descent, I have freckles on my arms and face. (Grandma told me they're angel kisses.) Went in for a work physical one time; after providing various samples for testing, had to do inverview with the physician. He asked me, "Okay, so what's the problem?"

"Problem? No problem, I'm just here for a work physical."

"But those spots on your arms, what's that all about?"

Serious doc? Helping him save face after that was beyond my skills of diplomacy.

[finley]

Whatever happened to the days when a doctor had a sodding microscope and a selection of stains on his bench, and knew how to bloody use them to distinguish between a fungus and a bacterium? My cat's vet is better tooled up than the average physician.

And as grandfeller suggested, there are plenty of doctors here who earned their degree online at the University of Um Bongo, or give every impression that they did.

Hope your blue ear returns to a more attractive colour soon.

[sandman]

I suggest a trip home. I just bet you'd get an appointment before next December.

[Hamletintaiwan]

Look at the bright side of it.
If it really flames up, you'll lose about 5kg.

By the way it could be a bacterial, fungal or even a virus infection like herpes.

I had one which I brought back from surfing in Spain. It came back every year, last for about a week, and made me lose a lot of weight.
The fifth time or so, I went to a hospital here in Taipei and asked them to give me a combination of the most powerful medication out there.

They gave me a two weeks course of medication, a handful of pills everyday. My joins started to make strange cracking noises after a week taking those pills.
I felt pretty sick from the pills also, but, after that, the ear infection never came back.

That was 10 years ago.

[Ducked]

I suggest a trip home. I just bet you'd get an appointment before next December.

This is true.

I've had negative experiences with doctors here, but I'm not at all sure that similar incompetence (the case I'm thinking of was rather more clearly incompetence but rather more complex to describe, so I havn't got around to it yet) couldn't happen in the UK NHS.

OTOH my impression is that access to resources (eg NMRI, bone scan) here has been MUCH better than it would have been in the UK.

I think the problem I percieve is to do with the "art rather than science" nature of the medical profession.

This is no doubt a comforting mantra for practitioners, but there's a risk that, along with time and resource pressures, it gets used as an excuse for doing a half-assed job of diagnosis.

There MIGHT be a cultural amplification of this unscientific approach, since the culture generally doesn't value logic, critical thinking, or evidence-based conclusions.

[sandman]

I suggest a trip home. I just bet you'd get an appointment before next December.

This is true.

I've had negative experiences with doctors here, but I'm not at all sure that similar incompetence (the case I'm thinking of was rather more clearly incompetence but rather more complex to describe, so I havn't got around to it yet) couldn't happen in the UK NHS.

OTOH my impression is that access to resources (eg NMRI, bone scan) here has been MUCH better than it would have been in the UK.

I think the problem I percieve is to do with the "art rather than science" nature of the medical profession.

This is no doubt a comforting mantra for practitioners, but there's a risk that, along with time and resource pressures, it gets used as an excuse for doing a half-assed job of diagnosis.

There MIGHT be a cultural amplification of this unscientific approach, since the culture generally doesn't value logic or evidence-based conclusions.

Git intae the queue! your you makin' a scene? Next please. Mrs. McGinty? You've been in line since 1987. Must be nearly yer turn wi' the doactur!

[Ducked]

Look at the bright side of it.
If it really flames up, you'll lose about 5kg.

If it really flares up, I stand to lose about 75 kg (IIRC), since its possible it could kill me.

Its more likely it'll just clear up, though.

P. aeruginosa which seems to be the best guess agent, is a tough little fucker and one of the main untreatable killer antibiotic resistant hospital infections.

Though I've no reason to believe I acquired this in hospital, even the wild types are quite resistant to treatment.

A P. aeruginosa ear infection can (rarely) develop into necrotising or malignant otitis externa, a life-threatening extension into the mastoid and temporal bones.

[Ducked]

And as grandfeller suggested, there are plenty of doctors here who earned their degree online at the University of Um Bongo, or give every impression that they did.

This is probably true anywhere, but it doesn't apply in this case, though my tendency to take the piss may have created that impression.

None of the Dr Lee's involved here gave an impression of incompetence, and I'm sure their opinions were based on sound training and experience.

This is awkward, since the opinions were quite different, with implications for treatment and probable outcome.

The difference is that the first Dr Lee acknowledged the limitations of his diagnosis and took steps to get further diagnostic information.

The second 2 Lee's, at a major teaching hospital, who were in a better position to confirm their diagnosis, and had been requested to do so by the referring physician and by the patient, declined, and initially, until argued with, didn't acknowledge other possible diagnoses. I don't think this is unusual.

I prefer the less confident approach.

[Ducked]

Hope your blue ear returns to a more attractive colour soon.

It was rather a pale, ducked duck egg blue.

Quite attractive, actually, if there'd been less of it, it'd been less smelly, and it hadn't come out of my ear.