Rash decisions

So, as a blogger, I feel overwhelming pressure to comment on Rathergate, the forged national guard memos that CBS won't retract. I've been waiting for some kind of quasi-medical angle, and Andrew Sullivan has provided it:

I think they so desperately wanted the documents to be legit that they rushed this story onto the air without taking the proper precautions. I know the feeling. I remember back when I was editing TNR, we were sent documents that seemed to prove that Senator Phil Gramm had once been in the KKK. Everything looked legit. And, of course, we were thrilled to have a big story about a politician most of us deeply disliked. But it's precisely the story that you want to be true that you have to be the most careful about. After many weeks of investigation, and much emotional investment in the story, the docs turned out to be fakes. Bummer, as far as we were concerned. The story never ran. I'm not bragging. It was self-interest that kept us from making an ass out of ourselves. And we were running a liberal opinion magazine, not a newspaper or "60 Minutes."

Ok, it's a bit of a stretch, but -- are you ready? -- this reminds me of something I've seen in medicine. Something I've been guilty of, no less.

Last week, I had a patient with a weeklong, worsening headache. Her neck was stiff, so triage had put her isolation (bacterial meningitis precautions). But when I pressed for associated symptoms, all she mentioned recent joint pain and malaise. Maybe a little fever a few days back. A few sniffles. On exam, however, I found an annular rash near her elbow. She said it'd been there for a year or so.

I really, really wanted my patient's rash to indicate Lyme disease (scroll down for pic). It could explain all her symptoms, it'd be treatable, and I'd impress my attending with my find.

Instead, the rash was ringworm. And the headache? a head CT showed... sinusitis. I ended up impressing the attending with a clean tap, she got some antibiotics and lamisil, and everyone went home happy.

In conclusion, I'm learning to resist the temptation to overinterpret a finding, because the truth can still lead to lucrative procedures.

But can it knock an anchor from his desk? And he said that irony is the shackles of youth. Uh huh.