frus...

I got a text message when I woke up in the morning... it was sent from the auto sms system to alert me regarding some major abnormality of the imaging I have order.

The message was a “suspect neoplasm/malignancy” alert regarding a 19 y/o female who had presented to ED for acute gastroenteritis. She had a intra-uterine device implanted (which made me remembered her…) and I had discharged her with oral medication yesterday.

As a physician serving as first liner in a small hospital; I do not enjoy the luxury of having a 24hrs radiologist support. We would get our report hours or maybe days later.

The message confused me as what kind of information could one gathered from a KUB film to reach a diagnosis of neoplasm.

I was a little bothered by the message and when I gone to work the next day and saw the report:

“… Moderate enlargement of the uterus is seen, myoma should be R/O….

I was a relief….well, fine at least I did not miss anything…

It was hours later when I got a similar text message which alert me of a patient whom I had just admitted to ward for pneumonia minutes ago.

The reports :

“  Abnormal opacity is seen in Rt middle lung field…”

No impression was noted but he classified the report as possible neoplasm…

This time, I am a little frus as I had noted in the application form that the patient was febrile and cough was noted.

There was a film which was taken 1 months ago and it was completely normal…

Well, nothing was mentioned about the pneumonia though…

It had been only 1 month and all the emergency medical staff was irritated by this new radiologist…

Radiologist is usually our last resort and if the radiologist is unable to give us a definite diagnosis(I am not asking 100% of the time but at least most of the time), it would be difficult for us... 

but the worst part was not giving a definite diagnosis for the situation but to raise some out of cosmo possible neoplasm diagnosis to further complicate the condition....