Indexing Title: OLEYSON’s Medical Anecdotal Report [05-07]

MAR Title:  X-ray say’s  

Date of Medical Observation: August 21, 2004

Narration:

It was another Sunday duty when, at around 6:00 pm, my sister informed me through text that her 3 year old daughter accidentally fell down from a 4 feet double bed. I knew from my sister that the accident happened when her daughter’s male cousin was trying to catch her while playing a game unfortunately, he failed. She felt a pain in her arm so her mother decided to call me and asked my guidance.

I told her to immediately bring her daughter to the hospital so I can see what I can do to help.  When they finally arrived, they met me at the emergency room. When I saw my niece, I do not have any idea if she is fine or in pain upon looking at her face. I checked on her arm, and did a thorough physical examination; it revealed no mass, no contusion, and no deformity, with good pulses, no weakness, and no cyanosis on the affected limb. 

I asked her if there were pains in her elbow, arm, wrist, and fingers, but she uttered, “Wala po” repeatedly. Basing on my physical examination my primary clinical diagnosis was negative for fracture. After a double check up doing a simple maneuver of her arm, my niece did no complaint. I opted not to request a paraclinical diagnostic procedure because of the degree of certainty that there were no fracture at the time of examination.

I decided to tell my sister that it seems everything looks alright and x-ray is not warranted at the moment. Weighing the benefit, risk, cost and availability of an x-ray it might do her harm from radiation exposure at her young age. My sister agreed to finally go home when after a few steps, I heard my niece painfully uttered, “ aray ko, masakit” and cried.

I then made a second thought of relying to a clinical diagnosis. I immediately requested an x-ray of the forearm right for the presence of pain and sent my niece to the x-ray room.  After waiting for the result, her x-ray showed an oblique fracture on her radius forearm right.   I called my sister about the result and told her that her daughter’s arm should be cast right away.  

Insights (Reinforcements, Stimulus, Discovery) (Ethical, Psychosocial, Physical)

We are blessed that we have been thought of patient management process but sometimes we may overlook some important details that we fail to arrive to the rational diagnosis.

In retrospect, while doing the physical examination, maybe my niece was just afraid of what I might found out that is why she uttered “ wala po” repeatedly.

As a physician we must be diligent in handling pediatric cases because most of the time they usually respond either negatively or positively during the course of the physical examination which maybe vital in arriving with a correct diagnosis.

Furthermore, critical information such as pain and absence of trauma signs can often lead us not to do a paraclinical diagnostic procedure which can be deleterious to the management of the patient.

Lesson learned from this experienced were to have high index of suspicion and the degree of certainty of the diagnosis to finally arrive in a rational diagnosis, to avoid medico-legal suits and complaint from mismanaged patients.