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Wednesday, October 21, 2015

Tricky Problems


It upsets me to collect a fee and then send a patient to a clinic or emergency room for care I can’t provide in a housecall. I try to anticipate these.

Many guests phone after a painful accident, hoping I can tell them it’s not a fracture. Sadly, unless it’s visible to the naked eye, I can’t. It turns out that medical science does little for broken toes, ribs, or noses, and most common fractures (arms, wrist, hand, finger, foot, ankle) are not emergencies. If a guest is willing to wait till office hours, I can make them an appointment with an orthopedist.

Upset stomachs make up the second most common ailment I hear about. These usually don’t last long, and I carry medicines that help. Stoics often prefer to wait. This is not unreasonable, but the longer symptoms – usually vomiting – last, the less likely that medicine will help. After about a day of vomiting this becomes so unlikely that I send the guest to where they can receive IV fluids.

Abdominal pain is usually benign in a young person but less so as the years pass. It’s tricky. Entire books have been written on it. I recommend Early Diagnosis of the Acute Abdomen by Zachary Cope, a British surgeon. He wrote it in 1921, revised it every few years till he died in 1971, and it’s still being revised. You can download it free; I suggest trying for the oldest edition. He’s a droll and witty writer, easy for laymen to understand.

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