David Jobson wrote:
>
> TO>In your message dated Monday 15, July 1996 Jon Wilcox wrote :
>
> TO>> With all this blatant honesty and rationalising of clinical
> TO>shortcuts,
> TO>> who will be totally honest and say they do not do PR's on suspected
> TO>> appendicitis.
>
> Toby Lipman replied:
>
> TO>I will. I NEVER do a PR on a suspected case of appendicitis. It's a
> TO>waste of time and unnecessary humiliation for the patient. A much
> TO>better test (in addition to the history and RIF tenderness +/-
> TO>guarding) is whether or not the patient can climb on to the
> TO>examination couch or sit up without pain or discomfort. If that sign
> TO>is positive I always admit the patient.
>
> And I almost never take the temperature either......
>
> The decision to admit (or not) is usually obvious and if not,
> more likely to be revealed by seeing the patient again in a
> few hours.
>
> And don't you just love those hosp docs who want to know over
> the phone the temp and PR findings .....!
>
> ______________________________________________________________
> Dr. David Jobson
Not to mention the vaginal examination... as soon as you mention "young
woman... appendix ... not clinically gynae pain". We get the usual
surgical retort (well quite often) how can you be SURE it is not gynae.
Have you done a PV? Have you done a chlamydia, and if not has she ever
had one? What do you MEAN it's not gynae pain.. etc. etc.
Indeed I had a young 22 year old woman last week who developed pain the
same day, clinically had appendicitis (rebound, peritonism). She didn't
need a rectal or VE and her temperature was normal. Histology came back
today as inflamed appendix. Understandably the surgeons are embarrassed
having to do a VE when it might (rarely) be needed, but one has to
respect the patient and the clinical relevence of the procedure. The
giveaway for this young woman was her unexpected excruciation upon
hopping on her right leg! Hopper's Sign perhaps.
JW
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