Indexing Title:  RJPeralta Medical Anecdotal Report

MAR Title:  Abrasion

Date of Observation: April 2008

Narration:

     One ER duty, the Department of ENT referred to us a case of a 25-year-old male who sustained contusion hematoma on the zygomatic area, left and multiple abrasions in the forehead, zygomatic areas, left and right and proximal third of the forearm secondary to mauling due to abrasion in the proximal third of the forearm left.  Blink.  Blink. Yes, the reason for referral is abrasion, proximal third, forearm, left. 

     Honestly, it really irritated me.  I mean, is there a difference in the management of an abrasion in the face and in the forearm?  Negative feelings aside, I informed my immediate senior of the said referral.  We both did our history and physical examination.  Yeah, it was just a superficial abrasion over the proximal third of the forearm, left. 

     Nothing more, nothing less.  She was also surprised but it is a referral so we answered it.  After cleaning the wound with soap, water, and issuing of medicolegal certificate from my senior, we returned the patient to the referring department. 

     After a few minutes, I called the ENT Resident and inquired if such referral is deemed necessary.  He said the patient is asking for a medicolegal certificate so he had to refer the patient because their department is concerned only with head and neck.  I said ok and bid goodbye.

     After that incident, I started thinking if that ENT resident did everything for that patient – referring a superficial abrasion to the department of surgery because it is not within the head and neck region, am I doing my patient good or harm if I am treating something who had a medical problem for example, UTI or an abrasion in the face?

INSIGHT: (Physical, Psychosocial, Ethical) (Discovery, Stimulus, Reinforcement)

Referrals have always been a source of dispute between departments in this hospital so they came up with guidelines to minimize this but in doing so, to  whose advantage is it?  The different departments or the patient?

In our department, our directive is to accept all referrals regardless of and that is what we are doing.

In this case, the ENT resident did what he has to do but in the long run, is it beneficial for the patient in terms of service or the time spent in the hospital?

     Yes, rules are rules but at times I think it should be bent to be applicable or appropriate in a situation.

     We all are doctors and not just doctors taking our specialty.