Who would you believe?

[chatenoire]

I have a skin problem. GP 1 gave me a fairly serious diagnosis that in an ideal world should be confirmed with a biopsy. GP 2 downgraded it to plain eczema. Dermatologist (via photos) changed it to inverse psoriasis. I tend to agree with the dermatologist, but I'm kind of iffy as she didn't see me in person. I've had three different diagnoses all fairly different from each other. At the very least it makes me distrust the GP surgery as they both got it wrong... (The FB group specialised in the condition I was originally diagnosed with thinks I should demand a biopsy, but I don't think I even have enough evidence to ask for one!)

I'd ask for referral to Dermatologist - they are the experts.

I've already had one! They're the ones who diagnosed based on photographs.

I'd be inclined to believe the dermatologist because it's their field but I'd ask to be seen in person to make sure.

I wouldn't accept any diagnosis unless I was seen in person. You can't afford to ignore GP1.

Unfortunately I don't think I can unless I don't respond to treatment. Which would be another 9 months... (I was originally referred to dermatology for something else) .

just go and see a private dermatologist

Yes, and I'm now paranoid about it, but I never had any symptoms of that condition.

There's only one locally! The others are about 1+ hours away. I don't mind driving, but I'd rather have some personal recommendation rather than just the only one I could find, or by a hunch on their profile.

Can you afford to go private?

As above it's not so much a matter of affordability but rather that I wouldn't know who to choose (plus travel).

I would trust the opinion of the specialist who, presumably, knew about the two GP diagnoses as part of the referral pathway? What I would be VERY clear about is the point at which you will return to the GP - it's not just if things don't improve, it is also if they worsen, or if you experience new symptoms. I don't think that would be a nine month interval, you are entitled to go back for any of the reasons I have mentioned.

Sorry but an hour isn't long to travel really, especially if you suspect it could be something serious.

I'd be inclined to believe the dermatologist (they will have looked at thousands of photos as part of their education and career so I don't think not being seen in person is an issue) and try their treatment and see if it improves.

Can you ask the dermatologist why they aren't considering diagnosis 1, and ask why they have decided on diagnosis 3?

Point out that if it's diagnosis 1 you don't want to wait 9 months of no improvement before returning.

That sounds like a reasonable response to me.

She would have read my notes. But the original referral was not for this... Dermatology messaged and asked for photos, which I provided but I made it clear the photos were for something completely different to the original referral.

The letter from dermatology does make note that a GP saw me, but they don't mention anything about previous diagnosis made by the two GPs.

Like I said it's not the travelling, it's the choosing blindly.

Hmm, not sure I quite understand - the original referral was for diagnosis one, but then another GP went on to give you a further diagnosis? Because you asked for a second opinion maybe? And when the referral date rolled around the dermatologist was more focused on the second diagnosis and didn't mention the first to you at all? I think you need a conversation with the dermatologist about the letter... did they talk to you at any point? I know you said you didn't see them in person, but was there a Zoom or a phone consultation? It's them you need to ask the questions that you are asking us. Can you contact them via their medical secretary and ask for a brief conversation to clarify the letter contents? There's some kind of disconnect here I think..?

No, the original referral had absolutely nothing to do with my current issues.

There was no conversation, no phone consultation. Just an app based questionnaire and a photo upload.

I have contacted the secretary (as I had a follow up question) and she told me any questions had to be channeled via the GP.

To clarify it was just sheer coincidence I had a referral in the works.

So you experienced different issues in the intervening time before you got to see the dematologist. Think I get it now - sorry it just sounded very confusing!

The good news, of course, is that the dermatologist must be confident in their diagnosis because if they were concerned then they would have insisted on a consultation (either virtual or in-person).

In which case then I think you need to do as the secretary advises and contact the GP. I can understand why you might have residual anxiousness due to the first GP's diagnosis, but it seems to have been overridden twice now by other professionals, including a specialist. I think I would be feeling a bit relieved!

Yeah got you now, that was the bit I couldn't understand. You experienced other issues in the intervening time that just so happened to be skin-related ones.

Ring the consultants secretary and ask for a face to face with the dermatologist and explain why.

To an extent! I did as I was told and the surgery replied, but the GP who replied didn't even bother to read my file. As he said "if you're itchy in that area do X and y" and that's the main issue :/ I was asking more about a nuance in the new skin routine.

I've already asked, and I was told I can't. That only if the treatment doesn't work and I'm back to the start of the queue (so 9 months!)

What area are you in? Perhaps someone can recommend a private dermatologist.

See that is the bit that frustrates me more than most - the file is easily available on the computer, even a cursory read would give them additional knowledge to help with their giving you advice. Ugh! Well wishing you good health and hope that things work for you, but as I said earlier, any change in symptoms or deterioration then get straight back on to them, sometimes it's hard to advocate for yourself in health situations, but it is so critical.