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Wed Aug 2 13:24:01 BST 2006

There was an interesting article in the Washington Post two weeks ago, about
how 2 US Med Students there were chided to look at the patient-- not to rely
on radiologic or laboratory findings. (Of pertinent, timely note-- both were
personally invited to Havana by Fidel Castro after being denied entry to US
medical schools. Most of us know the historically high quality reputation of
Cuban medical training.)

We had what I would have termed a textbook perfect physical presentation of
a young 30-something woman with an appendix. Her temp was 100, white count
was an unimpressive 12k and CT, equivical. The surgeon decided the pain
was probably caused by an incidental ipsilateral (right) ovarian cyst that
was less than 1cm, found on that same CT-- so small I did not detect it
on the pelvic exam.

The final disposition is that by the following afternoon, the pt was
afebrile, WBC was still 8k yet the she was walking around doubled over and
continued to be anorexic. After her surgery that afternoon, she was
relatively pain free and pathology returned an "acute appendicitis" report a
few days later.

Bottom line: look at the patient-- not the CT or labs.

C M Morris

On 8/1/06, Ronald Gross <Rgross at harthosp.org> wrote:
>
> I have now seen everything - and I am very sad.
>
> >>> <KMATTOX at aol.com> 7/31/2006 11:12 PM >>>
>
>
>
>
>
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