...and your argument is appreciated as well, but I did not mean to imply I
X-ray all "minor" mechanism injuries, merely that I do not ignore a possible
pathology merely on the basis of certain historical details. Litigation
plays no part in my decisions as I have no experience, but I did bring the
statistics in because they made sense.
I don't X-ray most sore toes. The vast majority, as most of you expect, I
manage "clinically". But that's mainly because, in my training, X-rays do
not play a role usually in their management, while in C-spine suspected
injury they do. How minor is minor is a question I also have no time for.
I am sure it might have happened to you, as it has to me, that a patient
came back with a "sore toe" for a second A&E visit. In my case I saw a
patient 6 weeks after a colleague at another hospital managed his
minor-mechanism stubbed 2nd toe with Clinical exam, neighbour-strapping and
the usual. I did the same exam and found NO definite abnormality, except the
to could not flex properly. So I sent him for an X-ray. Then I had to
re-iterate my ordr to the radiographer, whom I commend for inquiring before
doing what is, as you explain, an unusual X-ray.
Of course, the tow was dislocated at the pipjt. It was OK after an open
reduction. I know, becuase the patient is also a colleague of mine and I
also know there will be no litigation.
But I do not want someone finding a similar situation with a C-spine I
decide not to X-ray.
I will limit myself to one anecdote and therefore no comment on antibiotics
for sore throats...
But I do have one... If you really want it.
>From: "Adrian Fogarty" <[log in to unmask]>
>
>I appreciate your argument, except you could extrapolate that defeatist
>argument to pretty much anything; x-raying sore toes, antibiotics for sore
>throats etc. Actually I see many of these whiplash injuries months and
>years
>down the line, and the vast majority of them accept the initial doctor's
>clinical decision not to x-ray them and do not seek an x-ray elsewhere. The
>lack of x-ray does not affect the litigation process.
>
>Regards
>
>Adrian Fogarty
>A&E Consultant
>Royal Free Hospital
>
>
>----- Original Message -----
>From: Doc Holiday <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Wednesday, August 30, 2000 12:28 AM
>Subject: Re: Necks in A&E
> > A further minor point (have referred to others in previous e-mail). I
> > believe that many patients who have neck pain in these circumstances and
>are
> > not X-rayed will eventually get an X-ray from GP/re-visit to A&E,
>because
> > symptoms often persist and someone ends up requesting it. So any saving
>in
> > "unnecessary radiation and clogging up" might be false/temporary.
>
>
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