.:reflective practice from the Portfolio:.
Describe the event:
I saw an 8 year old boy complaining of headache and left ear pain for two days. I took a history and examined him, looked in the ears, at his dentition, feeling the cervical lymph nodes and the parotid area. He was swollen and exquisitely tender over the left anterior cervical lymph nodes. I didn't come to any conclusion, as the ears were fine and the teeth didn't show any abscess.
So.. I went to ask one of my seniors about what to do next. I was thinking of a developing abscess in one of the cervical lymph nodes and thought of asking for an ultrasound of the neck the next day.
When the senior came to have a look he asked me if the throat is OK and I said yes, then realising I haven't actually looked in the throat. And of course the patient had a very enlarged left tonsil with pus points on it, thus giving the diagnosis of bacterial tonsillitis.
So.. I went to ask one of my seniors about what to do next. I was thinking of a developing abscess in one of the cervical lymph nodes and thought of asking for an ultrasound of the neck the next day.
When the senior came to have a look he asked me if the throat is OK and I said yes, then realising I haven't actually looked in the throat. And of course the patient had a very enlarged left tonsil with pus points on it, thus giving the diagnosis of bacterial tonsillitis.
What did I think and feel?
I couldn't believe my stupidity in forgetting to look in the throat but actually thinking I have done it. I felt so ashamed that I missed such a simple diagnosis because of an examination blunder that I cannot really explain to myself.
I went back to the notes and there was actually written by me that the throat was clear (??).
I then realised that was has happened is actually a very good thing - It's a "tap on the shoulder" to remind me that anyone can make mistakes and forget things. Also it's a good reminder that examination should be thorough and very organised.
I went back to the notes and there was actually written by me that the throat was clear (??).
I then realised that was has happened is actually a very good thing - It's a "tap on the shoulder" to remind me that anyone can make mistakes and forget things. Also it's a good reminder that examination should be thorough and very organised.
What were the context / factors which had an influence on the event?
It was 10 pm and I was probably a bit tired, having seen all day patients in the minors area. This was the first patient I was seeing in the minor illnesses area.
Looking back what could I have done differently?
Not knowing exactly why I thought I actually examined he throat I don't know what I could have done differently. Maybe drink a cup of coffee during the evening break.
What were the key learning point(s) from this event?
1. anyone can make a mistake
2. do the examination and write the notes in a very organised manner
3. ask if you don't know. Someone else might see things which are blatantly obvious but invisible to your eye and clinical acumen.
2. do the examination and write the notes in a very organised manner
3. ask if you don't know. Someone else might see things which are blatantly obvious but invisible to your eye and clinical acumen.
No comments:
Post a Comment