Indexing Title: DCHUA’s Medical Anecdotal Report [04-3]

MAR Title:  Depth of Understanding

Date of Medical Observation: 2004

Narration:

 4/F was brought for consult at OM ER after accidentally stepping on burning plastic.  She was crying and had charred skin plantar to the whole big toe.  My co-resident scheduled the patient for debridement.  I mentioned to him that it appeared to be a 3rd degree burn that probably needed plastic surgery skin coverage.  He insisted that the patient's wound would heal uneventfully with simple debridement.  We subsequently placed a monetary bet on the outcome.

A few days later, on making my rounds, I noted normal skin on the previously burned site.  I realized then that the plantar skin was so thick that the peeling charred portion did not even penetrate the dermis.

I have yet to pay up on my bet.

Insights (Discovery, Reinforcement, Stimulus):

Discovery:

Charred skin does not necessarily point towards a 3rd degree burn.

Reinforcements:

Not everything is as it seems.  Observing changes and patterns are better than single evaluations.

Not everything one reads is correct.  Perhaps because there are written qualifications to all things written that one hasn't read yet and couldn't realistically read.

Stimulus:

One should not be too sure of one's self, regardless of previous experience or having read references.  Closing one's mind to other possibilities counterfires.  Developing humility enables one to analyze even an uneducated or biligerent drunk patient's seemingly irrational claims for elements of truth and saliency.

Don't make bets.