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    An ophthalmologist’s experience with tele-medicine

    Not long ago, whilst on my way to work, I found myself listening to one of those call-in doctor radio programs. People gave their first names and then described some problem they, a family member, or a friend were experiencing. The all-knowing medical expert would then ask a few questions and steer the caller in a certain direction. 

    Not surprisingly, the doctor had an appealing voice and was empathic. He felt the pain of his callers.

    And perhaps not surprisingly, a lot of the calls seemed to deal with issues around eating too much or drinking too much. Sometimes drug use came up. Psychiatric illness, including depression, seemed like a common issue. No eye problems were brought up.

    Then a young voice came on the phone. This caller was a college freshman. She was excited to begin her education at her university (which I had once visited) but lately she had developed a problem. She wanted to know what would cause her to lose large amounts of scalp hair and feel extremely tired all the time. "I want to lie in bed and sleep much more than ever before in my life," she said. She went to the student health clinic and the primary care doctor there tested her for anemia and iron deficiency, but said the tests results were normal. No one knew what to do to help her at this point, she said.

    I waited with baited breath, as they say, to hear the call-in doctor give her the likely diagnosis and tell her to see the right physician.

    Instead, he asked her, "Do you have any rashes or other problems?"

    “No, except for the hair problem. I just feel extremely fatigued all the time," she replied.  

    "Tell her what she probably has!" I thought to myself. But the radio savant asked her again if she had a rash somewhere on her body or any other problems. She repeated that no, she only had the striking degree of hair loss and the aforementioned extreme fatigue.

    The doctor demurred. He was pretty sure it wasn't iron deficiency anemia (not a surprise, given that she'd already tested negative) he said, but thought it was likely to be caused by some sort of medical problem. She should go to see a good dermatologist, was his recommendation.  He wished her well before he hung up and went to the next caller.

    To be fair, it's hard sometimes to think of things on the spot, so we often think of things we wished we'd said only later. So maybe it isn’t fair to second guess the call-in show physician.  But I was disappointed that this young college student, far away from home and experiencing distressing problems, wasn't getting more useful information from the doctor.

    My differential diagnosis

    Peter J. McDonnell, MD
    He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of ...

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