Don’t be so damned precious about medical skills. Ten years ago or so I had a right axillary lump of which I had complained to my GP for the preceding four years. The good Dr Christian finally offered a diagnosis of Hodgkin’s Disease, or as a differential diagnosis non-Hodgkin’s Lymphoma.
I attended OPD where somebody’s house-surgeon offered me a consent form to sign for removal of my right lymphatic system at some later date. My response was ‘No sir, don’t be such an aunt, we’ll have a needle biopsy, thank you very much’. Upshot was chief was summoned, needle biopsy performed, and the odour of the ripest Stilton you can imagine pervaded the room, whilst the houseman screamed ‘Get some of this!’ to the attending nurse.
There were giant cells, evidence of caseating necrosis, and lymphatic tissue. Nothing could be cultured, but this is very often the case with TB, of which I am sure you are aware. Could well have been some NTM infection, such as
# Mycobacterium Avium-Intracellulare
# Mycobacterium Chelonae
# Mycobacterium Fortuitum
# Mycobacterium Gordonae
# Mycobacterium Haemophilum
# Mycobacterium Kansasii
# Mycobacterium Marinum
# Mycobacterium Xenopi
The whole point of this is that consent must be informed. Three and a bit years ago I had an anterior resection of the bowel to remove a couple of adenomous carcinomas, prior to which I had asked my colo-rectal bod if he would examine my left kidney, earlier shown by CT scan to host three sub-centimetric cysts. He said that he would not do this but his post-operative report makes interesting reading. Quite apart from grizzling about my ‘short fat mesentery’, which made the procedure more difficult, he spent time examining my liver, which I had not asked him to do, managing to discover ‘two small structures’ that felt like ‘sand grains. We’ll not mention here the idiocy of the anaesthetist, mainly because she apologised while I was still an in-patient.
Yup, consent is important, informed consent more so, but where a procedure is requested and refused, I do not expect to have another procedure conducted without medical necessity.
I’m not sure quite where you hang in the medical tree, though I have seen you make diagnosis at a distance which is inexcusable