The exam showed minor pain and no soft tissue swelling. Perhaps a little point tenderness over the distal fibular growth plate. X-rays showed open growth plates (see orange arrows), but no other injuries. I discussed the possibility of a Type 1 Salter Harris injury and the generally excellent outcomes. I recommended rest, ice, and crutches. Asked the tech to place an air splint on the patient’s ankle.
“She can’t use crutches. She needs a wheelchair. And an air splint isn’t going to protect her ankle well enough.”
“Why can’t she use crutches?”
“The last time she injured her ankle, the orthopedic specialist told her she needed a wheelchair. He wrote her a prescription for the wheelchair. She was in it for at least a month in school.”
I looked through our medical records. No previous visits. Turns out the incident the mother described occurred in another state.
“I can’t comment on what happened before or the reason that the orthopedist believed she needed a wheelchair for a month, but it looks like she’s more than capable of using crutches now. We’ll show her how to use them before we discharge you.”
The patient apparently was on board with the mother’s plan. Even though she could hop on one foot from the wheelchair in the room onto the bed without problems, she nearly fell over twice when they were crutch-training her. One time, she landed on her bad foot and screamed in pain. That sent mom into a rage.
So they got what they wanted. Short leg splint. Wheelchair for two days. Mandatory orthopedic follow-up within that time period.
Then comes the Press Ganey comment several months later.
“Doctor was rude and dangerous. Wouldn’t listen to me when I told him that my daughter needed a wheelchair for her injury. Missed an obvious fracture through both bones on my daughter’s x-ray. Tried to get her to walk on her bad leg and when she did, she fell, causing a worse injury to her ankle.”
Of course, there is no way to respond to these untrue statements. And the complaints are taken as true by hospital administrators.
In retrospect, I probably should have just admitted her and put her in traction for a couple of weeks.
This and all posts about patients may be fictional, may be my experiences, may be submitted by readers for publication here, or may be any combination of the above. Factual statements may or may not be accurate. If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail me.