Before ordering the damn MRI to "rule out osteomyelitis", please take apart the dressing and look at the effing wound first. Or read the wound care notes.
Sincerely,
CrankyKong,MD.
(after a horrible weekend spent batting cleanup)
Sunday, July 12, 2009
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6 comments:
sorry, just had to vent. I am the weekendist for my group Sometimes my partners' antics mystify me.
You must be seeing soft mushy bone in the wound.
Sometimes I think they don't teach the residents physical exam/diagnosis anymore.
Either that or I have super-human hearing for heart murmurs that the previous four examiners didn't hear.
There was no soft mushy bone, Dr.. Steve. I personally debrided the wound in the ER because I couldn't wait for wound care to come in. Sure it was a dirty homeless guy. But it was an infected blister. Huge, but far, far away from the bone...Wound care doc said same.
These guys must have gone to med school at the same university complex as one of my nurses who charted fundal height on a post-partum TAH/BSO for three days! For the love of PETE, doesn't any specialty teach basic assessment/examination!!!
Kranky Karen, MSN
I wouldn't even mind if you don't take off the dressing, at least order a damn plain film. When I go show your 3 phase bone scan (because your patient was too fat to fit in the MRI and we've got a 500 pound weight limit (or they can stay on their damn bed)) to the radiologist and he asks why there isn't a fucking xray, how about I call YOU up and let him bitch at YOU?
Oh, I get it now, Cranky. I thought they were ordering MRI to "R/O osteo" in a patient with obvious osteomyelitis on physical exam.
You were at the other end of the spectrum, and it's just as bad . . . and expensive.
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