more on qualified physician parasitologists

Mark Siddall msiddall at umich.edu
Wed Feb 26 01:19:25 EST 1997


Just to offer my $0.02 regarding whether or not physicians are trained
enough in parasites...

An eternal cynic, I ran my own experiment...
A patient (me!) presented with chronic (>2 mo) GI distress accompanied
by intermittent diarrhea, bloating, excessive gas etc (Sorry for the
details).
Without solicitation, my primary care physician (not a specialist)
immediately inquired if I had been out of the country recently.  "Why
yes," I answered, "South Africa in December with my fiancee."  

"Did she come down with anything?" he inquired.  I answered in the
affirmative "Campylobacter jejuni".   "Have you seen any blood,
yourself?" he added.  "Nope" I said.  "Well it can't be that, besides
you would have been here long ago, but it does make it likely that you
were exposed to something related to food handling."

Then he explained to me the details of how low-grade Giardiasis matched
my symptomology pretty well and proceded to recount even the specifics
of what would be expected of a patient's narrative like "things just
don't come out the same as I am used to" etc. 

He handed me specimen collection containers, one with NBF and one with
mercuric chloride specifically labelled for ova and cyst recovery,
prescribed metranidazole without having to look it up, counselled me on
how ridiculously sick I would feel if I even sniffed alcohol while on
it.

I inquired about starting the medicaiton right away and he said "Nope,
get the specimens together so we don't blow the diagnosis, then go on
it."  

I then revealed that I am a parasitologist and inquired ass to why I
wasn't to collect specimens oevr a longer period (as I thought
appropriate for Giardia).  He replied that, in fact, the diagnostics had
gotten better of late and two sucessive days should be fine for the
local parasite lab to make a determination.  

So... in fact, this fella, a primary care physician, was reasonably well
versed in the symptomology, diagnostics, treatment and side-effects
thereof, and willing to admit, too, that there are a whole host [sic] of
things that it could be besides, but this was a reasonable and
predictable start.

Mark

PS: I'm not crazy about metronidazole.  Tastes awful.



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