Possibly submitted from a reader e-mail

A patient comes in complaining of swelling to her right foot. No pain. No injury. Just swelling.

A quick glance at the patient’s foot showed that there was no swelling whatsoever. Examination … nothing. Range of motion … normal. However, the patient insisted that her foot was swollen.
“Where do you feel that your foot is swollen?”
“Look. Right here,” pointing at the outer ankle.
“Um … ma’am. That’s your ankle.”
“No … that’s swelling.”

So I went and got a tape measure. I measured around both feet, around both ankles, and around both lower legs, then compared numbers. Exactly the same in both legs.

“See? The sides are the same. No swelling.”
“Yeah, well your tape measure is wrong.”
“But I used the same tape to … Nevermind. Well. This is kind of beyond the scope of my practice. I think I’m going to need to refer you to the vascular surgeon and the orthopedist to be worked up for the swelling. In the meantime, we’ll wrap your foot with an ACE bandage  and you’re welcome to take some Motrin for your symptoms. Have a nice day.”

If you have a patient story you’d like to see published on this blog, please e-mail it to me at whitecoat at epmonthly dot com.



    • If this were my patient, and depending on the hospital I’m working at, the closest vascular surgeon is an hour’s drive away and the orthopedic surgeon on call would just happen to be one who likes to talk down to all of us unintelligent “ER docs” who never seem to know how to put on splints correctly.

    • If this were my patient, I might be concerned about patient satis…fac…tion. Can’t ruin that streak of straight 5’s.

  1. Is there a such thing as internal swelling? I can see it where the pt. feels pressure inside their leg but not enough to restrict range of motion or show up externally. Either way though, not an emergency.

  2. If by refer to every possible specialist you mean, “covering my ass” than I understand. I don’t think it’s prudent but I very much understand. Although, I don’t think ‘head cases’ are covered under medicaire, so if they had private insurance or were a private pay…f*** ’em.

  3. I can’t tell how may times I’ve seen patients for “a rash” that I couldn’t see.

    Also, the patients with “a rash, now gone”. They get mad when I can’t tell them what it was even though I never saw it. Here’s a hint, when the rash disappears while you are in the waiting room, it’s OK to go home.

  4. ODD – I’d wonder about mental health, vision or being punked …because so strange.

    Like …if some friends got together with faux ins, etc and got someone to pretend …just to bust you. Probably not possible because everything in the system now.

    Annoying for doc …but funny post. 🙂

  5. I’m shocked at the lack of care. Obviously, this patient needed leeches to be applied to the affected area, until the swelling resolved.

  6. This is a surprisingly common chief complaint actually. That and a “rash” that only the patient can see.

    Of course, where I work, the rashes only the patient can see get their Bactrim and Keflex or whatever and the swelling only the patient can see patients all get a DVT workup.

Leave A Reply