For those who had skin abscess - was CT involved in diagnosing?

[tenant13]

I recently developed a quarter sized abscess right in the middle of my buttock. I went to ER and they insisted on doing abdomina body cat scan with contrast. I balked at first and asked about ultrasound but they insisted on the CT.

I obviously have no clue what is and what is not necessary when diagnosing these things. To make a long story short, CT was the only thing they did - I was sent home with an antibiotic and the problem resolved itself two days later.

I wouldn’t want to dispute the procedures that were truly necessary but 3k later I’m curious if this is the way a typical skin abscess is diagnosed and treated.

 

[Teacher Terry]

My son gets these occasionally and they lance it to let the infection out and give him an antibiotic. He’s had this problem for years especially on his buttocks. They never do a CT.

 

[Montecfo]

That's does seem a bit much.

 

[HawkeyeNFO]

CT = a MASSIVE dose of radiation

 

[latexman]

I recently developed a quarter sized abscess right in the middle of my buttock. I went to ER and they insisted on doing abdomina body cat scan with contrast. I balked at first and asked about ultrasound but they insisted on the CT.

I obviously have no clue what is and what is not necessary when diagnosing these things. To make a long story short, CT was the only thing they did - I was sent home with an antibiotic and the problem resolved itself two days later.

I wouldn’t want to dispute the procedures that were truly necessary but 3k later I’m curious if this is the way a typical skin abscess is diagnosed and treated.

No disrespect, but I can't help wondering, maybe they were trying to send a message, like wasn't it overkill to come to an ER for a pimple on the butt? Use warm compresses to draw it to a head, pop it, and put Polysporin, Neosporin, or Bacitracin on it. Once you buy the tube of antibiotic ointment, it has to be about a $1 each time.

 

[tenant13]

No disrespect, but I can't help wondering, maybe they were trying to send a message, like wasn't it overkill to come to an ER for a pimple on the butt? Use warm compresses to draw it to a head, pop it, and put Polysporin, Neosporin, or Bacitracin on it. Once you buy the tube of antibiotic ointment, it has to be about a $1 each time.

That's exactly what I'm asking: were they trying to fleece me? Because if the message they were sending was, "you're an idiot and and we'd like to show you how expensive not using Google for you medical treatment is" then I think I got it and I would like to send a message to them by filing the complaint with the insurance.

 

[latexman]

That's exactly what I'm asking: were they trying to fleece me? Because if the message they were sending was, "you're an idiot and and we'd like to show you how expensive not using Google for you medical treatment is" then I think I got it and I would like to send a message to them by filing the complaint with the insurance.

I wasn't there, but it sure feels like that is a possibility to me.

 

[Teacher Terry]

No disrespect, but I can't help wondering, maybe they were trying to send a message, like wasn't it overkill to come to an ER for a pimple on the butt? Use warm compresses to draw it to a head, pop it, and put Polysporin, Neosporin, or Bacitracin on it. Once you buy the tube of antibiotic ointment, it has to be about a $1 each time.

My son’s abscesses just keep growing bigger and he always needs to see a doctor. Originally he thought that they would go away and there’s no way to pop them at home because the infection is so deep. They can be really awful and painful.

 

[MissMolly]

My son’s abscesses just keep growing bigger and he always needs to see a doctor. Originally he thought that they would go away and there’s no way to pop them at home because the infection is so deep. They can be really awful and painful.

Your son may have hidradenitis suppurativa. https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview He should talk to a dermatologist that has experience treating this disease. Most regular doctors have no knowledge of this. He can get on medication to help control this. It is not curable.

 

[tenant13]

My son’s abscesses just keep growing bigger and he always needs to see a doctor. Originally he thought that they would go away and there’s no way to pop them at home because the infection is so deep. They can be really awful and painful.

I obviously did spend time on internet trying to figure out what was going on but the information was swinging between: “use warm compress and it’ll go away” to “it can destroy you and your life forever, run to ER right now!”. I did the first, it didn’t help so I panicked and did the second. I’m fairly hypochondriac which paid off when I was in the middle of a heart attack. Not so much this time.

I have spoken to a couple of doctors since and they said that based on my description, the CT was not necessary. ER could have just used ultrasound.

The thing is: I KNOW that doctors in US are getting paid based on the amount of administered diagnostics and procedures so I don’t trust their recommendations. Having said that, I also have no choice and have to follow those recommendations. I’m not a doctor.

 

[Scrapr]

That's exactly what I'm asking: were they trying to fleece me? Because if the message they were sending was, "you're an idiot and and we'd like to show you how expensive not using Google for you medical treatment is" then I think I got it and I would like to send a message to them by filing the complaint with the insurance.

At least they didn't proscribe a MRI. aka another boat payment

 

[Aerides]

A few thoughts:

The ER probably has standard protocols to follow, and I think it's highly unlikely they have the time or inclination to require more than needed. ER's a busy places with real emergencies and people die in them daily. ER staff generally are not prone to playing games.

How much did you ask them about this? I'd be "wow, what are the possible things a CT would reveal or rule out?" I'm very chatty and friendly through things like this, and it works.

All that aside, rather than play dr google (or in addition to it), my first action would have been to make an appointment with a dermatologist. Or a PCP. Or urgent care. Plenty of other options to take when symptoms first start vs. "eh, home care it'll go away".

 

[tenant13]

A few thoughts:

The ER probably has standard protocols to follow, and I think it's highly unlikely they have the time or inclination to require more than needed. ER's a busy places with real emergencies and people die in them daily. ER staff generally are not prone to playing games.

How much did you ask them about this? I'd be "wow, what are the possible things a CT would reveal or rule out?" I'm very chatty and friendly through things like this, and it works.

All that aside, rather than play dr google (or in addition to it), my first action would have been to make an appointment with a dermatologist. Or a PCP. Or urgent care. Plenty of other options to take when symptoms first start vs. "eh, home care it'll go away".

Lesson learned. Interestingly there was absolutely nobody else at the admission room and maybe two more people inside.

On the side note, my last ER visit was in Chiang Mai in Thailand. I fractured my toe. That cost me $70. And my latest emergency dental visit in Buenos Aires was $12 + $11.50 for the panoramic x-ray of my teeth. Those are places where I just paid out of pocket. The “explanation of benefits” I got from my US insurance is a stack of papers that does not explain anything and between the quoted price of $6500 and what I owe ($3k+) is the most confusing thing I’ve ever seen.

 

[Teacher Terry]

Your son may have hidradenitis suppurativa. https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview He should talk to a dermatologist that has experience treating this disease. Most regular doctors have no knowledge of this. He can get on medication to help control this. It is not curable.

Thanks for the information. I will pass it along to him.

 

[dmpi]

We have a emergent care clinic where you can be seen by a doctor without an appointment. It's actually a much more comfortable setting than an ER. I would reserve the ER for cases that are real emergencies like excessive bleeding or trouble breathing.

 

[EastWest Gal]

A few thoughts:

The ER probably has standard protocols to follow, and I think it's highly unlikely they have the time or inclination to require more than needed. ER's a busy places with real emergencies and people die in them daily. ER staff generally are not prone to playing games.

How much did you ask them about this? I'd be "wow, what are the possible things a CT would reveal or rule out?" I'm very chatty and friendly through things like this, and it works.

All that aside, rather than play dr google (or in addition to it), my first action would have been to make an appointment with a dermatologist. Or a PCP. Or urgent care. Plenty of other options to take when symptoms first start vs. "eh, home care it'll go away".

Your primary care physician should be able to treat an abscess of that size (a quarter).

Your wrong about ERs doing just the minimum. They often do the maximum, and do much more than they need to do. They try to take care of everything possible, and overkill and overbilling is a feature of ERs. But a CT scan for a quarter sized abscess in a location far from the abdomen? No. Just no.

Also, a dermatologist probably won't see any patients with an abscess. Some abscesses in some locations require hospital admission and IV antibiotics. Most do not. A CT scan is almost never done, and there was no need for an abdominal CT scan for a small abscess on the buttock.

I think they went way overboard, and you may even consider complaining to your state insurance commissioner. I had situations twice when my son had a fractured arm and a fractured heel bone. The ER code was for critical care for the fractured arm, and for the heel bone the ER coded comprehensive care for a simple splint. I saved a couple of thousand dollars pursuing the upcoding, and reported the problem in the second instance.

I've treated many abscesses during my career, and except in certain locations and sizes such as on the face, around the eye, and tonsillar, there is no need for any imaging in most abscesses.

 

[HarveyS]

But, maybe they just wanted to cover their butt when they worked on your butt.

 

[tenant13]

Your primary care physician should be able to treat an abscess of that size (a quarter).

Your wrong about ERs doing just the minimum. They often do the maximum, and do much more than they need to do. They try to take care of everything possible, and overkill and overbilling is a feature of ERs. But a CT scan for a quarter sized abscess in a location far from the abdomen? No. Just no.

Also, a dermatologist probably won't see any patients with an abscess. Some abscesses in some locations require hospital admission and IV antibiotics. Most do not. A CT scan is almost never done, and there was no need for an abdominal CT scan for a small abscess on the buttock.

I think they went way overboard, and you may even consider complaining to your state insurance commissioner. I had situations twice when my son had a fractured arm and a fractured heel bone. The ER code was for critical care for the fractured arm, and for the heel bone the ER coded comprehensive care for a simple splint. I saved a couple of thousand dollars pursuing the upcoding, and reported the problem in the second instance.

I've treated many abscesses during my career, and except in certain locations and sizes such as on the face, around the eye, and tonsillar, there is no need for any imaging in most abscesses.

Thank you. You're one of the several medical professionals that told me the same thing. I did try to avoid that scan altogether - and then asked if ultrasound could do the job if imaging was necessary - but they said they needed to find out "how deep" the abscess reached and it sounded plausible to me. Plus it wasn't up for a discussion. I also had tons of blood tests done to the tune of hundreds of dollars and a saline drip emptied into my vain. It ALL seemed excessive.

 

[Route246]

I had a dime-sized one on my hip a month ago. Didn't know what it was, sort of freaked me out and went to urgent care. The physician assistant explained it, told me warm compress and light massage and it should subside in a few days. Almost on schedule that is what happened. I kept a bandage on it and it drained as expected.

CT scan? Isn't that like using a sledge hammer to kill a cockroach? Whew!!!

 

[tenant13]

I had a dime-sized one on my hip a month ago. Didn't know what it was, sort of freaked me out and went to urgent care. The physician assistant explained it, told me warm compress and light massage and it should subside in a few days. Almost on schedule that is what happened. I kept a bandage on it and it drained as expected.

CT scan? Isn't that like using a sledge hammer to kill a cockroach? Whew!!!

So it seems. I've only received several "explanation of benefits" aka This Is Not A Bill letters from the insurance. One the hospital sends the actual invoice I will look into disputing this whole ordeal.

 

[RetiredHappy]

I am going to be playing the devil's advocate here. You elected to go the ER as opposed to going to your PCP. When someone goes to ER, it means that the person is hugely concerned about their medical condition and that it is also time critical in getting a resolution. ER's purpose is to diagnose the patient's condition and to eliminate potential life threatening causes immediately. They are not there to fleece the patient. Every doctor diagnoses a case differently from another. You had an ER doctor who was very cautious. You made a mistake in going to the ER, but it was your choice.

 

[tenant13]

I am going to be playing the devil's advocate here. You elected to go the ER as opposed to going to your PCP. When someone goes to ER, it means that the person is hugely concerned about their medical condition and that it is also time critical in getting a resolution. ER's purpose to diagnose the patient's condition and to eliminate potential life threatening causes immediately. They are not there to fleece the patient. Every doctor diagnoses a case differently from another. You had an ER doctor who was very cautious. You made a mistake in going to the ER, but it was your choice.

Seeking medical help was clearly my choice but as you yourself wrote: "ER's purpose to diagnose the patient's condition". It's not that my doctor was cautious - she was incompetent. Imagine you go to an ER with an acute lower back pain and end up with a spine surgery when a cortisone shot an a rest would work - by your logic that would be patient's fault.

 

[Rambodoc]

As a recently retired Emergency Physician of greater than 30 years experience l may be able to shed some light on why the physician evaluated you as they did. You, unfortunately do not give the reader any of your past medical history that may have been instrumental in the decisions made. For instance are you a diabetic, are you over 60, any family history of lower gastrointestinal cancers, or any history of diverticulitis. Do your labs show any abnormalities, did you have a fever on arrival to the emergency department. You also don’t say where on your buttocks was the lesion. If the lesion is near the anus that could easily have arisen from the lower gastrointestinal tract and extended to where the butt pimple was found. This can be rather common and require surgery to fix. It would entail dissecting out the sinus tract leading to the locus of the infection which is often an infected diverticula. This is notoriously difficult to diagnose on ultrasound. If missed this could easily worsen and lead to severe complications or death. This is just one diagnosis that could easily be found on the ct scan. The differential diagnosis of a butt pimple is long and varied and includes several very serious diagnoses that can not be missed. Unfortunately as a practitioner in the emergency department we only have one swing of the bat to get it right. We will probably never see you again as a patient. We don’t have the luxury of the personal physician who can see you several times and has a long standing relationship with you. The emergency physician is often sued because of this and has one of the highest malpractice insurance rates in medicine. So you can see why they may err on the side of completeness when diagnosing a possibly serious condition.
In essence I don’t think your physician was incompetent. Without knowing more of your symptoms, history, labs it is impossible to double guess her evaluation. I think she did a thorough evaluation for the complaint you presented with. I hesitate to think what your response would have been if she had not done a ct scan and you did wind up with a severe diagnosis that would have required surgery or worse.

 

[tenant13]

As a recently retired Emergency Physician of greater than 30 years experience l may be able to shed some light on why the physician evaluated you as they did. You, unfortunately do not give the reader any of your past medical history that may have been instrumental in the decisions made. For instance are you a diabetic, are you over 60, any family history of lower gastrointestinal cancers, or any history of diverticulitis. Do your labs show any abnormalities, did you have a fever on arrival to the emergency department. You also don’t say where on your buttocks was the lesion. If the lesion is near the anus that could easily have arisen from the lower gastrointestinal tract and extended to where the butt pimple was found. This can be rather common and require surgery to fix. It would entail dissecting out the sinus tract leading to the locus of the infection which is often an infected diverticula. This is notoriously difficult to diagnose on ultrasound. If missed this could easily worsen and lead to severe complications or death. This is just one diagnosis that could easily be found on the ct scan. The differential diagnosis of a butt pimple is long and varied and includes several very serious diagnoses that can not be missed. Unfortunately as a practitioner in the emergency department we only have one swing of the bat to get it right. We will probably never see you again as a patient. We don’t have the luxury of the personal physician who can see you several times and has a long standing relationship with you. The emergency physician is often sued because of this and has one of the highest malpractice insurance rates in medicine. So you can see why they may err on the side of completeness when diagnosing a possibly serious condition.
In essence I don’t think your physician was incompetent. Without knowing more of your symptoms, history, labs it is impossible to double guess her evaluation. I think she did a thorough evaluation for the complaint you presented with. I hesitate to think what your response would have been if she had not done a ct scan and you did wind up with a severe diagnosis that would have required surgery or worse.

"No" to all your questions (diabetes, cancers, gastro issues, family history, fever and all that). The hospital I attended is part of a larger medical center and they have my medical history documented in their system. I turned 60 last September and the abscess was right smack in the center of the glute, very clearly right under the skin - nowhere near the perineal area.

Question: when a patient that is not in a middle of a life threatening situation shows up at ER - with something like abscess - do you explain the condition and present the possible ways of resolving it? Or is that only something that happens during regular visits at the doctors? Say, you go to a cardiologist and he looks at your tests results and gives you options of 1) either changing your lifestyle 2) taking a bunch meds daily 3) administering stress test or coronary calcium scan or even 4) installing a stent (I'm just hypothesizing).

I do think that this was an inexperienced physician who was "cautious" not for my sake but hers. So she looked up recommended guidelines and follow them to the letter.

 

[John Galt III]

So it seems. I've only received several "explanation of benefits" aka This Is Not A Bill letters from the insurance. One the hospital sends the actual invoice I will look into disputing this whole ordeal.

And what did the EOB say? Did they pay for it? Did you owe a deductible or a coinsurance?


Did they deny the claim (in which case you may owe nothing) ?