There was this female patient admitted to a local regional hospital for facial cellulitis. She is a k/c of diabetes mellitus and hypertension. On D2 of admission, a computer tomography was done and the doctor (? infectionist) had told the family that a great amount of pus /a.k.a abscess was noted in the face and debridement was needed. Unfortunately no plastic surgeon was around and a referral was needed. 2 place was offered - another regional hospital and a medical center(medical center > regional hospital > area hospital) . The family opted for regional hospital as there was bed available. The patient was seen in ED and later admitted to ward. In the ward, the atteneding physician/?surgeon saw the CT and told the family that massive pus is also noted and debridement is urgent and warranted but again they were unable to perform it. So the patient was again referred to the medical center. As no bed was available - the patient was placed in the observation ward in ED. However in the observation ward, the oncall CR told them that only a samll amount of pus was noted and no surgery was needed...
Facts of the day -
1.Physician/ Surgeon cannot read CT without the radiologist - the medical center had 24 hrs coverage of radiologist and the smaller hospital did not...
2.General surgeon trainning is not sufficient - I+D of face could not be done by a board certified surgeon(general)
3.The doctor cannot differential diagnose an abscess from a cellulitis -( or maybe too cold this few days - the doctor thought that the abscess will be iced and stoney hard on palpation...?)
well - there is still someone who earn something in this case - the ambulance driver... 2 referral cost the family at least NT 5k....
this happened to a friend's mother......last night.....
anyway - happy new year....
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