Snuff box prod = adequate examination.

Ladies and gentlemen, behold an oxymoron. :-)

Best wishes


Rowley.



-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of John PASKINS
Sent: 31 August 2005 16:54
To: [log in to unmask]
Subject: Re: Sacphoids[Scanned]


If the notes describe an adequate exam, (snuff box, 1st MC compression etc.)
a comment about swelling or not, and movements and mode of injury ,then, if
after all that someone felt that it was not appropriate to X-Ray then there
would be good indications that this decision was the result of clinical
investigation such as would be given by any other properly trained or
supervised practitioner in emergency medicine. So it passes the Bolam test.
It would be hard to suggest that with all these negative findings that an
x-ray would be "Irmer allowed "so it would not be reasonable for an expert
to say it should have been done. 

>>> Nick Jenkins 08/31/05 04:33pm >>>
As we're getting into the legal bit now maybe what I should be asking you
wealth of Expert knowledge out there is - if YOU were the Expert in such a
case would you be satisfied that the doctor had documented an absence of
scaphoid # signs and say something like 'the doctor made adequate clinical
tests for a fracture but no signs were present'  OR would you say ' a
fracture has been shown to be present,  therefore the scaphoid must have
been tender, 
and the doctor's examination must have been inadequate' - how do we counter
that latter argument?  Does anyone know of any evidence that this can
happen?
- or is this discussion the only evidence there is whereby a number of us
have said that we've seen this happen before?

-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]]On Behalf Of Adrian Fogarty
Sent: 31 August 2005 16:01
To: [log in to unmask] 
Subject: Re: Sacphoids


I think you're confusing liability, causation and quantum (damages). Pain
and suffering are part of (general) damages, but the claimant can only make
a successful claim for damages if they can prove the case on the issue of
liability, i.e. if they can show that the doctor (or NHS trust) was
negligent, and next if they can prove causation, i.e. that the negligent act
led to the pain and suffering. The precise extent of that pain and suffering
is part of quantum. So, if there is no negligence then there are no damages.

AF


Tony Adams <[log in to unmask]> wrote: 

In my opinion, the fact that the diagnosis of a fracture is missed does not
necessarily equate to negligence.  Because we are professionals, I
understand that the Bolam test would apply.  The standard that is set must
be a reasonable standard by which to judge a professional carrying out
his/her duty.

 

Also, the fact that a patient/client makes a successful claim for
compensation because of pain and suffering does not mean that the healthcare
professional had been negligent either.  Compensation for pain and suffering
does not equal negligence.  Where we might avoid successful claims might be
in the advice - verbal and written, we give to patients.  For example, a
leaflet that says, "Your x-rays show no evidence of a fracture, but in x% of
cases there might still be a fracture.  If you continue to have symptoms you
should ..."

 

Thoughts?

 

Tony Adams

 

-----Original Message-----
From: Accident and Emergency Academic List
[mailtoo:[log in to unmask]] On Behalf Of Nick Jenkins
Sent: 31 August 2005 10:51
To: [log in to unmask] 
Subject: Sacphoids

 

Dear all. 
The scaphoid problem is a well known old nutshell and our Departments all
vary
as to whether or not we even follow them up in A&E,   and for those that do,

how we follow them up.

We do follow them up in our dept. and have an algorithm which employs a low
threshold for MRI scanning. 
I've noticed,  however, a trickle of cases where scaphoid fractures have
slipped through un-detected,  and those case unsurprisingly often end up as
complaint / litigation cases.  What does surprise me when reviewing the
notes is that those cases commonly have explicitly documented an absence of
scaphoid tenderness at 5-7 days  - and often by sensible doctors who's
judgement I trust - and hence those cases haven't progressed down the 'low
threshold for MRI scan' route.

My question is not whether A&E should follow them up - or how we should
follow them up - but to ask whether anyone else is aware of this phenomenon
of what, 
in retrospect is a fractured scaphoid,  having no signs that would point us
down whatever investigation route that we use?  If it is a true occurrence
it would seem that we are on to a loser unless we scan (or whatever) every
wrist injury regardless of signs.

Any comments?  Many thanks, 

Nick Jenkins 
A&E Consultant, Abergavenny 
http://www.emergencynhh.co.uk 

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