Q: My grandmother who is now around 72 years old recently had her toe amputated. She's been going to this male doctor (who has been known for his reputation and care for the elders) for years, for a regular checkup and for her foot problem. The doctor diagnosed her with athlete's foot and gave her ointment and medicine for treatment. However, we noticed that her foot condition did not go away. In fact, her hands and her feet became extremely cold every time we saw her. Recently she fell in the middle of the night and ended up cutting her toe, which quickly became swollen and discolored. When she was taken into Emergency, a foot specialist told her that she never had athlete's foot. Instead, her foot problem was due to diabetes; she was misdiagnosed all this time! The bad news was that as a result of this finding, her toe had to be amputated right away due to serious infection and complications with blood clotting. What would be a wise thing to do if someone is misdiagnosed? Also, how would you know which physician to trust? (In our case, the doctor's reputation did not help much) and how quickly would you make a decision to operate if you had to under an emergency?
Confused in California

A: In a nutshell, the answer is to seek a second opinion, ask questions, and inform yourself. With your grandmother's foot problem, the first clue that a second opinion may be in order is that the condition did not go away. Athlete's foot is not hard to cure! The second clue was the cold feet. That kind of symptom should never be ignored. Was it brought to the attention of the primary physician? Every symptom, no matter how trivial-seeming, should be reported. One thing you can do on your own is to consult self-help medical references There are a number of excellent books that are available at most libraries. Ask the Librarian to help you search. The Internet is another source of information, as long as you consult sites hosted by reputable medical groups. That's just to get some background information about the symptoms. This may help you ask more informed and useful questions of the physician.

     Then seek a second opinion from a specialist in the appropriate medical area. The "second opinion" is a standard feature of modern medical practice; if the primary physician objects, you have the wrong physician. Do not use one of the primary physician's friends; use someone new. Check with the county medical association and ask for a recommendation. Or better yet, ask the residents and nurses at your local hospital. They're insiders who are knowledgeable and likely to be fairly objective. Don't use physician referral services; they merely advertising. Inquire about the second physician's credentials-specialty, years in practice, where he or she is board-certified (this means they have completed specialized training in the specialty area), etc. Not all so-called specialists actually have the appropriate training. The easiest way to find out if the physician is board-certified is to call the toll-free number of the American Board of Medical Specialties (1-866-ASK-ABMS) or access its web site.

     As for the last question, the key is asking intelligent questions. What symptoms led to the diagnosis, what other alternative diagnoses are possible, what are the risks and benefits of the intervention, what are the risks and benefits of waiting to make a decision, and of course, is there another physician available of whom to ask a second opinion?

     In this particular case, the diagnosis was so off, you might also want to consider filing an official complaint with the county medical association.

     If you want to know more about how to be an informed consumer of medical services, one of several excellent books available at many libraries is Examining Your Doctor: A Patient's Guide to Avoiding Harmful Medical; Care by Timothy B. McCall, M.D. It's also still in print, if you want to have your own copy handy at home.