27 August 2011

Issues with shoes

My patient, a homeless man in decent health, came to our volunteer clinic because he had "athlete's foot" and wanted an anti-fungal.

When I asked him to remove his shoes and socks so I could take a look, he refused. I pointed out that most doctors won't write a prescription for something unless they can examine it. He still refused and wouldn't say why. He cooperated with the other parts of the exam.

I brought in the attending physician, who asked to look at the foot. No dice. The physician and I conferred:

What's going on here? Maybe he doesn't have athlete's foot and he's getting it for a friend? Maybe it smells really bad and he's embarrassed?

We ultimately gave him a tube of prescription topical antifungal (we didn't have non-prescription). There isn't much you can do with antifungal cream (would it get you high if you snorted it?) and we didn't think there's much of a black market for Lamisil. We probably helped someone's athlete's foot, although who knows if it was the patient's.

I don't know which is more incredible: that the patient thought he could get anti-fungals without showing us his foot, or that he got just that.