Frustrating to Get Unclear Instructions from a Resident

I finally got an answer to a question that has been dogging me. But the answer was confusing, and I was left to unravel it for myself despite my best efforts at getting a clarification.

Since I’ve been dealing with skin cancer for years, this was not the end of the world. But for someone who is new at it, the kind of answer I got could be a bigger problem.

Challenges with comorbidities

And with my dual health challenges – the long-term aftereffects of my stem cell transplants on the blood cancer side and my chronic squamous cell skin cancers – the confusion was just one more thing to unsettle me. Or in other words, not what I needed. Or in more other words, a pain in the rear. Or more specifically, a pain in the thumb.

Worried about my thumb that wouldn't heal

If you’ve read any of my posts, you know that I’ve been worried about a tiny hole in my thumb. It was created by a squamous cell cancer treated in different ways. I had Mohs surgery on it, but the spot didn’t heal. It kept bleeding. I had it frozen, but still it didn’t heal.

I made a special appointment just for the thumb. A resident did a biopsy while my dermatologist supervised.

Finally, I thought, a resolution was in sight.

The resident left me a voicemail saying it was a very superficial squamous cell carcinoma again. She said she wanted me to keep using the creams I have been using and to apply Efudex twice a day for two weeks. She said she would follow up with a phone call.

Unclear instructions left on voicemail

But wait, she said creams, not cream, I thought. Yet she only mentioned one cream. There is a difference. The creams that I have been using, Efudex and Dovonex, are applied for a shorter duration, usually between five and seven days, depending on the location. (Shorter time periods are for the face.)

If I am in the office, I ask the dermatologist to write down the instructions. No matter how many times I’ve done it – and I’ve treated a lot – I like to see it in writing. But all I had to go on was this confusing message. She did not call me back. She did not leave a direct extension.

Futilely calling for more information

I tried to call the main number. That was about as much fun as when the needle goes in to give you the anesthesia before a biopsy or Mohs surgery.

Press 1 for COVID information. Press 2 for billing. Press 3 if you want to complain about your taxes. Press 4 if you want a weather report. Press 5 if you want to know what we’re reading. Press 6 for Dr. A, 7 for Drs. B, C, and D, 8 for Dr. D, and don’t even try pressing zero even though in the old days you could do that. Sorry, you have been disconnected. Well that was fun. I never did get through.

Emailing didn't work, either

I emailed my doctor but did not hear back.

It just so happens that I have an upcoming appointment.

I made an executive decision to treat with the combination cream for two weeks. I did it “under occlusion,” meaning I covered the area with plastic wrap.

But seriously, folks, we patients should not have to figure these things out for ourselves. I’ve done it enough times that I’m pretty sure I’m not over treating.

I’ve tended to under treat, because over at Mohs surgery, my doctor, who specializes in high-risk patients, often tells me that I have to do it longer. But what if this one time I was over treating?

I wonder if medical school training includes the nitty gritty of being specific with patients, of following through and following up. If not, it should.