Referral blue

Boss had approached me after my long break. He had related the case that he had encountered 2 days ago during his ward call.

Our neurologist had submitted her resignation 1 month ago and after some serious discussion and compromised; she had agreed to stay with the condition of waiving Sunday ward call. The immediate “lobang” were filled by Boss as usual.

A 7 y/o boy with abdominal pain was admitted to the pediatric service on Saturday. He was seen on the next day where the pain had worsened. Clinically the symptom favor acute appendicitis; but boss had chosen to do a CT for confirmation. The radiologist was consulted for final decision and a report ruling out of acute appendicitis was done. Boss had informed the family about the report but on Monday, when the surgeon saw the kid and CT. He had concluded that he favored acute appendicitis and with the diverted result, the family had asked for transferred to a tertiary facility immediately.

Acute appendicitis had been one of the “notable” diseases in my memory. One of my elder cousin had been mis-diagnosed at the age of 6 and ended up with a long HORIZANTAL laparotomy scar over his belly….
We were told not to jump nor run after meal as it may lead to acute appendicitis( a myth of coz) by our parents during our childhood.

I was cautious with this disease from D1 of my practice. Our new surgeon had wanted a CT scan for confirmation and he had ruled out 10-20 percents of the clinically favored acute appendicitis. He performs appendectomy only during office hour; cases who presented after office hour would be admitted and given parenteral antibiotic and surgery would be delayed to the next morning.

I learnt to differential diagnosis acute appendicitis on CT after his arrival.

I do not blame the radiologist for the report but yet our consultation system is the major culprit.

In the standard version of referral consult, a the relevant physician/surgeon should see the patient personally but yet some of the them do the consultation over phone or via communication app.

We had complaint multiple times regarding the setting and now finally our Boss had it….Hopefully some change will be done in the future..