Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, September 25, 2009

Op Note

That Hatchling sure is enjoying his senior year. Look what he just sent me:

Date: 9/24/09 12:30
Patient ID: Surgical Medical Student
Preop Diagnosis: Cellulitis with abscess, R medial ankle
Postop Diagnosis: Same
Procedure: I&D R medial ankle pustule
Surgeon: Surgical PA
Assist: Surgical Medical Student (aka the patient)
Anesthesia: Beer was requested and denied by the PA
Blood Loss: none
Urine: not measured

Procedure Note: Patient removed right sock to display prominent 1.5cm diameter pustule overlying an erythematous region of approximately 10cm in diameter posterior and inferior to the medial malleolus. The procedure and risks were discussed including loss of sensation, generalized sepsis, and possible need for amputation should complications arise; informed content was obtained. Liability was discussed and patient agreed to waive all liability for the procedure.

Patient requested a beer for anesthesia but this was deferred due to location and unavailability. Patient proceeded to drape in a non-sterile fashion with absorbent chux. He then prepped his own foot with rubbing alcohol and betadine.

At this time the PA instructed him to lie back and relax. She then attempted to shield the incision site from the patient. The patient proceeded to call the PA an ass, and promised not to move during the incision; he remained seated upright so he could see. The PA proceeded to make a 1cm postero-inferior incision across the middle of the lesion. Immediately purulent material flowed from the wound causing the two nursing students observing the procedure to say "ooh". Despite the stoic demeanor of the patient, no phone numbers were obtained.

In total about 2-4cc of purulent material was expressed from the wound with not so gentle force. Pressure was again used to ensure hemostasis. It should be noted that the PA seemed to take pleasure in causing the patient to grimace with excessive pressure. The wound was dressed with a 2x2 gauze and the patient was told to return to work immediately because they needed the room. Patient was discharged with a script for Keflex 500mg QID to treat the remaining cellulitis. Patient was instructed to keep the leg elevated when possible and continue using warm compresses to treat the remaining cellulitis. Patient is expected to be noncompliant and lost to follow up.

Signed: Surgical Medical Student 4

I have seen and attest to the above statement as the attending
practioner: Surgical PA


At Sat Sep 26, 12:09:00 AM, Blogger Amanda said...

reads much like that youtube video

At Sat Sep 26, 12:14:00 AM, Blogger Mule Breath said...

Outstanding charting. Two thumbs up.

At Sat Sep 26, 11:42:00 PM, Blogger Midwife with a Knife said...

You must be so proud! :)

At Sun Sep 27, 03:40:00 PM, Anonymous Anonymous said...

Very entertaining. Only nit is the grammatical fingernails-on-chalkboard effect of "At this time the PA instructed him to LAY back and relax."


Kensington MD

At Mon Sep 28, 10:19:00 AM, Anonymous Anonymous said...

Hysterical, Dino. Thanks for sharing. I didn't know one of your dino eggs was following in your footsteps. How cool.

At Wed Sep 30, 07:05:00 PM, Blogger ShrinkingDoc said...

That's hilarious!

At Thu Oct 08, 01:39:00 PM, Anonymous Bob T said...

A right medial ankle sounds like a horrible orthopedic congenital defect-


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