When do we NOT treat plantar warts?

When its not a wart!

ok! so the title is misleading, but this is a terrific example of how clinical care can go sideways very easily. This patient was adamant that they had a plantar wart (viral skin infection), they had one previously treated successfully and wanted this on treated the same way.

After several attempts to redirect, our practitioner was able to explain that the presenting lesion was not characteristic of a plantar wart, and more importantly, they could see something reflecting light embedded in the tissue.

Image of the bottom of a foot with a small piece of glass embedded

With the patients consent and a little gentle debridement of the lesion, a fragment of glass was removed from the tissue. Further debridement and palpation ensured that this was a single fragment and a sterile dressing could be applied.

The patient was immediately able to weight bare pain-free and walk out of our office .

The lesson to be learned is that we will all be a patient one day in a medical office. By all means, be proactive and research your condition, even the treatments available and suitable specialists. Once in that office assist the in their information gathering and examination so that they can make a good diagnosis and offer the best advice regarding treatment if necessary. Then is the time to voice your concerns regarding diagnosis or treatment preferences. With a good explanation and exchange of information, you will be in an informed position to choose the appropriate plan for you. Your clinical specialist is only human and if pressed aggressively from the beginning of your visit, may choose the path of least resistance and fulfill you wishes. 

When I go to see my general physician whom Ive known and practiced next door to for some 20+ years, he often greats me with “Mark what do you need?”. Invariably my answer is “I need your diagnostic skills!”.

The old addage to this story is a physician who treats themselves, has a fool for a doctor!