CHAPTER 8 – A 15 YEAR OLD GIRL WITH RLQ ABDOMINAL PAIN:
IT IS AN APPY… RIGHT?
The other day I worked with someone who ordered a CBC for the evaluation of RLQ abdominal pain. “Why,” I asked. “The surgeon wants it.” Well, my thought is that if the surgeon is called, on that few percent of abdominal pain patients who actually have a surgical problem, we can order it after the CT results shows the appy.
This does sound a bit ‘high and mighty’; it is very standard practice to order a terrible test, such as a WBC count, when you are getting a very great test, such as a CT scan. Then here is the lession, if the CT is negative, and the WBC count is elevated, document in a progress note why you don’t think something bad is happening.
This elevated WBC count hurt the doctor in court and hurt the patient at the second visit (when it was low) causing the surgeons to suspect viral gastroenteritis (who is still diagnosing a viral syndrome with a low WBC count? – surgeons, I guess.) Who did it help? No one.
Plaintiff cross examination of the defense expert witness: