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Articles and features 05/09/2013

Robodoc

Robodoc

Time to read article: 7 mins
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Patient safety in healthcare has never been more in the spotlight. Events such as the Stafford Hospital scandal and the subsequent Francis Report have raised awareness that at times patients receive suboptimal care.

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Case report 01/09/2011

Right level, wrong site

Right level, wrong site

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Mr G, a 40-year-old manager, saw Mr S, a spinal surgeon, in his consultation room with a short history of sciatica. Mr G presented with two weeks of back pain and pain radiating down the front of the left thigh to just below the knee.

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Case report 01/05/2011

Avoiding unnecessary surgery

Avoiding unnecessary surgery

Time to read article: 2 mins
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Mrs A, 50, had initially consulted her GP with heartburn and some minor weight loss. A gastroscopy was performed and demonstrated Grade A oesophagitis with a small hiatus hernia. Mrs A was started on a proton pump inhibitor; however, her symptoms persisted and she asked to see a specialist.

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Case report 01/05/2010

The one and only

The one and only

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Mr H, a 20-year-old sports student, presented to his GP complaining of an intermittent left groin swelling and pain in the same area when exercising. On examination, the GP noted a reducible swelling in the left groin consistent with an indirect inguinal hernia. He referred Mr H to the general surgery department of his local hospital, where Mr H was seen four weeks later by doctor in training, Dr T.

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Case report 01/09/2009

Consent? No sweat

Consent? No sweat

Time to read article: 2 mins
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Thirty-year-old Mr P had suffered from facial and palmar hyperhidrosis and blushing since he was 14. Over the years, he had tried various over-the-counter remedies and a period of psychotherapy with no success. Although he had learned to live with his condition to some extent, he found it socially inhibiting and believed that it was preventing him from progressing in his career as an accountant.

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Case report 01/09/2009

An unnecessary operation or two

An unnecessary operation or two

Time to read article: 2 mins
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Mrs R, aged 40, was referred to consultant general surgeon, Mr P, complaining of long-standing abdominal pain, abdominal distension and severe hiccups. Mr P performed an upper gastrointestinal endoscopy and found a small sliding hiatus hernia, but no oesophagitis. Mrs R had already been treated with proton pump inhibitors by her GP, but had experienced no improvement in her symptoms.

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Case report 01/05/2008

We don’t talk anymore

We don’t talk anymore

Time to read article: 2 mins
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Mr Y, a 35-year-old marine engineer, was undergoing surgery in the posterior compartment of the thigh to treat a congenital vascular lesion. Mr O, consultant vascular surgeon, was carrying out the procedure. The lesion was closely related to the sciatic nerve and some of its branches, and Mr O was hoping to avoid damaging the sciatic bundle, if possible.

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Case report 01/01/2007

Telling right from wrong

Telling right from wrong

Time to read article: 3 mins
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Mr B, a 56-year-old retired builder, consulted his GP, Dr R, complaining of right-sided scrotal discomfort, of several months duration. He had no previous urological history, and the preceding year had taken early retirement. On examination, the GP noted a small epididymal cyst, which was tender to palpation.

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Case report 01/01/2007

A testing case

A testing case

Time to read article: 3 mins
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Mrs R, a 52-year-old union official, had been attending her local medical outpatients department for three years, under the care of Dr G, general physician. Dr G had diagnosed giant cell (temporal) arteritis when she was first referred by her GP, Dr Y. Mrs R gave a classical history of temporal headache, generalised weakness and malaise. She had a significantly elevated ESR.

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Case report 01/01/2007

A problem with the system, not the patient

A problem with the system, not the patient

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Mr C, a 47-year-old self-employed electrician, was admitted for a routine arthroscopic menisectomy of the knee. He was in good health and did not take any regular medication. His past medical history was unremarkable. He was keen to resume his active lifestyle, and return to work as soon as possible since he was the sole breadwinner. Preoperative assessment confirmed that he was healthy and fit for the procedure.

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Case report 01/02/2006

Video nasty

Video nasty

Time to read article: 2 mins
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Mrs P, a 37-year old housewife, presented with recurrent attacks of biliary colic. Gallstones were confirmed on abdominal ultrasound and Mrs P consulted Dr H, a general surgeon. Dr H arranged a laparoscopic cholecystectomy, warning the patient of the risks of open conversion, but did not mention more serious complications.

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Case report 01/05/2005

Warning signs

Warning signs

Time to read article: 3 mins
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Mr Y, a 41-year-old father of five, was involved in a high-impact, head-on road crash late at night on a country road. He was wearing a seatbelt and was able to talk to the ambulance crew when they attended. On initial assessment, his BP was 140/90 mmHg with heart rate at 120 bpm.

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Case report 01/05/2004

A forgotten lump

A forgotten lump

Time to read article: 2 mins
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Miss T, a 15-year-old schoolgirl, consulted Dr F on several occasions about her recurrent sore eyes. During one consultation, she drew his attention to a small lump in the right anterior triangle of her neck that had appeared more than a month earlier.

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Case report 01/05/2004

No consent, no defence

No consent, no defence

Time to read article: 2 mins
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Mr B, a banker in his thirties, had a hiatus hernia; he suffered from chronic heartburn, which had not been alleviated either by ranitidine or a hiatus-hernia repair. In the early 1990s, his GP referred him to Mr M, consultant general surgeon, for gastroscopy.

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Case report 01/02/2004

Vein or artery?

Vein or artery?

Time to read article: 3 mins
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Mrs T, a housewife in her thirties, was in the first trimester of pregnancy. She’d had trouble with lower back pain, which suddenly intensified one Sunday morning. She attended her local out-of-hours co-operative and coincidentally saw her own GP, Dr F.

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Case report 01/02/2004

Patient was ill-informed

Patient was ill-informed

Time to read article: 2 mins
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During a balloon dilation of Mr P’s oesophagus at the site of previous surgery, Dr U, a specialist in general surgery, noticed bleeding as he removed the gastroscope. He could not see any perforation because blood in the oesophagus was obscuring his view.

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