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製薬業界で 12 年以上キャリアを持つ Sharon 先生による医療コラムをお届けします。
特集：医療英語 > Case 4: Retained Foreign Body - 残存異物 -
12 年以上製薬業界の第一線で活躍する Sharon 先生が 2004 年 12 月より不定期でコラムを持つことになりました。最近の製薬業界の動きや医療に携わる日本人が英語を話す時に注意すべき点等、比較的自由に書いてもらおうと思っております。書いて欲しい記事などございましたらレッスン中に Sharon 先生にお伝え頂くか support@manabi.st までご連絡ください。
Retained foreign body
A 12-year-old boy complaining of abdominal pain was seen in the emergency department. Upon examination, his vital signs were stable and he was afebrile. His right lower quadrant was tender to the touch and showed rebound and guarding. CBC showed a moderately elevated white blood count and urinalysis was normal. The patient had taken Tylenol but the pain did not respond. A consult with a pediatric surgeon was scheduled, after which the surgeon diagnosed appendicitis and decided to operate.
The operation was performed the same day and confirmed the diagnosis of appendicitis. The appendix was removed successfully and the recovery period was without complications. The patient was discharged.
Two months later the patient returned to the emergency department complaining of abdominal pain and fever. The attending physician ordered a CBC and urinalysis. The CBC revealed a slight elevation of white blood cells and the urinalysis was normal. The patient was told to take Tylenol and follow up with his pediatrician if the pain did not subside.
The next day the patient returned to the emergency department complaining of considerably worse pain, fever and vomiting. CBC and urinalysis were unchanged. A CT scan revealed an abscess near the cecum. The physician consulted the pediatric surgeon and he decided to operate. During the operation the surgeon found what appeared to be a piece of gauze that was apparently left during the appendectomy two months before. The abscess was drained, the gauze removed and a Penrose drain was left in the wound so that drainage could continue. The boy recovered without further complications. The pediatric surgeon (who had performed both operations) apologized to him and his family.
The boy and his parents filed a claim against the surgeon for negligence.
In general, suits over retained foreign bodies are difficult, if not impossible, to defend. The surgeon refrained from finger-pointing or blaming an assistant, and he sincerely apologized to the patient and his family. In addition, the hospital agreed to waive all charges for the operation to remove the gauze and drain the abscess.
Discussion questions
- Please summarize this case. What is the main point of the article?
- Was the patient's initial work-up complete?
- Were the diagnosis and treatment appropriate?
- Was his second work-up complete?
- Were the diagnosis and treatment appropriate?
- Should the surgeon have apologized?
- Was the surgeon negligent? Why or why not? If so, what is a fair settlement?
