Sunday, 24 February 2008

Not doing us any favours

I had a referral from a fellow NP recently. 'Patient has painful wrist, ? fracture. Needs an Xray.'

Now I'm a miserable bastard , and lazy, at the best of times and dislike this approach. If you think the patient, needs an Xray, then refer them to Xray, with a signed request. Don't expect me to do your work for you!

Anyway, I thought I'd better chat to the patient first, just to check out his story.

Right handed manual worker.

Painful right wrist for a week.

No history of injury to wrist.

Pain worse on exercise, moving wrist.

So. I took a look at his wrist.

No swelling, bruising, redness or deformity.

I had a feel.

No bony tenderness at wrist, elbow or hand.

Tender over Abductor Pollicus Longus.

Grating/creaking sensation on moving thumb.

Finkelstein's test +ve.

Cut and dried case of Tenosynovitis. No Xray needed, revealed by simple history and physical exam. Missed by a colleague who didn't do the basics.

The patient was very impressed, he did wonder why he had been told to come for an Xray as he didn't remember injuring himself. He was amazed that the NP in the surgery had managed to decide he had a bony injury without looking at his wrist, never mind prodding it to see if he squealed.

We have had a long hard slog to gain acceptance as NPs in whichever field we practice. There are many out there who detract from us, label us as quacktitioners, and mock our work.

Don't give the bastards any ammunition!


Advanced Practitioner said...

Fully agree and well said!!!

Fat Lazy Male Nurse said...

This doesn't do us any good whatsoever. After the struggle some NPs have had to be able to request Xrays in the past, this kind of caper really isn't on.