Confused by Primary Care doctor inaction

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July 12, 2017 at 3:10 pm  #1291069    

willowtristis

I am currently a medical student with a passion for Hematology/Oncology.

An individual close to me asked if I would take a look at his blood work from the past two years, which he was told showed some minor abnormalities. He did not feel like he was getting a clear understanding of the situation from his doctor and hoped that I might offer insight.

After reviewing, I fear that he is in the early stages of CLL. He has had a consistently elevated absolute lymphocyte count for almost 2 years now (>8.0 K/uL over the past year), relative lymphocytes between 67-69%, persistent mild thrombocytopenia (114 K/uL), and smudge cells present on his peripheral smear.

I discussed my concerns with him and encouraged him to return to his doctor to ask for a more in depth interpretation/evaluation of the results.

The doctor’s response: “Your results show some minor changes in the platelet count and white blood count. I have reviewed these with Hematology and their opinion is to simply track these counts over time as they are not significantly off. If you have any questions or concerns, please feel free to contact our office.”

That leads me to my questions: Am I missing something here? Is there a chance that this isn’t CLL? And if it is CLL, why won’t the doctor discuss that with the patient?

I can understand not wanting to alarm the patient yet, but if there is an obvious diagnosis, doesn’t the patient have the right to know and have it explained to him? Am I completely wrong about my interpretation of the results?

While I know that CLL is not something to be acutely alarmed about, and that the course of action right now will likely be to watch & wait, I am incredibly bothered that this isn’t something his doctor is choosing to diagnose or officially discuss with him and get additional testing for. Am I wrong??

Thank you in advance.

July 12, 2017 at 8:39 pm  #1291071    
JimC Forum Moderator
JimC Forum Moderator

Hi willowtristis,

Welcome to GRACE. I am sorry to hear of your friend’s concerning blood work results, and that both he and you don’t feel that his doctor is providing a full explanation and/or diagnosis. Based on the blood tests I understand your concerns, although speculating about a specific diagnosis is beyond what we can offer on this website, for a number of practical and legal reasons. Of course you’re absolutely correct that a patient should have a diagnosis fully explained to him. Although I’m not suggesting it is what is happening here, the days of the kindly family physician withholding troubling information to spare the patient should be in the past.

The best course may be to obtain a second opinion, preferably at a major teaching hospital. Providing the relevant medical records to a “second set of eyes” should help remove doubts about the diagnosis and suggested course of action.

JimC
Forum moderator


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