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Baffled by Breathing Problems Con't.
Feb 25, 2001

Since my question earlier about my friend, he has been admitted to the hospital. Previous to his admission, he was diagnosed by his primary care physician with pneumonia. He was sent to a pulmonolgist for further care. The pulmonologist diagnosed him with Asthma, Infiltrates and Atelectasis. He had a CT Scan prior to his admission which was unremarkable. They treated him with inhalers and anti-biotics for the pneumonia. On 01/18/01, he experienced severe pain while he was at work in his lungs. He said it felt like someone was stabbing him. On 01/19/01, his pulmonologist admitted him into the hospital at which time they put him on IV anti-biotics. The pulmonolgist did this because of the x-ray abnomalities. The next day a CT Scan was performed, he was taken off of anti-biotics by the infectious disease doctor because he said he did not know what they were treating and was recomending a bronchoscopy. The following day, the pulmonologist decides to do a bronch because he said the scan indicated pathology and it might be KS. In my earlier question, I mentioned the purple like bruises on his back which no doctor felt it was KS.

The latest...the purple spots on his back are a skin infection, the doctor did not say what kind. The spots are changing colors and they plan to do another biopsy. The bronchoscopy did not reveal lesions and they did take samples of fluid to test. His primary care physician wants him to remain in the hospital until the test results are back from the bronch, the infections disease doctor says he can go home and should have another CT in one month to see if the pathology has progressed. There is no conclusions at this time. In addition, my friend and his pulmonologist got in a rather heated argument that I feel the doctor was did not respond appropriately. He desperately wants to know what is going on with his lungs. He asked the pulmonologist why he did not explore more of his lungs. The doctor said if he did not agree with his treatment the to fire him then and there, that he was busy enough without taking care of him. Not only do I wish to have your opinion about the recent medical information, but what a patient can expect from his doctor professionally. How can a patient fire the only pulmonoligist on his plan and still get treated? Is there a way to make a complaint about the doctors behavior? Can a doctor refuse to treat a patient because the patient demands that he not be rude and treat him with respect? What about when patients disagree with their doctor because the patient does not feel enough is happening to diagnose? He wants a biopsy to find out once and for all what is happening to his lungs. He is afraid when they decide it will be too late. Thanks.

Response from Dr. Feinberg

If your friend's plan has only one pulmonologist, then he should contact the plan administrators and make a complaint. It may be that the doctor was frustrated and impatient because he didn't have any answers for your friend-- that doesn't excse his rudeness, but may explain it. In my book a physician should always try to see things from the patient's perspective-- clearly your friend is frightened and worried.

That said, biopsies have their own risks, including the possibility that it may not be diagnostic. If your friend's condition is stable, waiting a while to repeat the CT scan is not entirely unreasonable.

Nodules on Lungs

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