Remember that weird pelvic xray with the unidentifiable item on it last week? Click here to review it. Lots of interesting guesses came in on this one. Two people got close, but not close enough.
Here’s a picture of what we found when we logrolled the patient to examine the back. See if you can figure it out and leave a comment before I post the complete answer later this morning.
I’d like to thank everyone for their comments. An unregistered user just left a comment on a post on local wound exploration that I published 6 months ago. It poses a good question and I don’t want it to get lost in the archives. Click here to see the old post. I’m going to do a post next Wednesday entitled “The Art of Local Wound Exploration” that should answer everybody’s questions about this.
And so far, no one has figured out the weird pelvic xray below.
Michael
Here’s a perfect item for April Fool’s Day, although it is for real. The xray below was a pelvic image obtained during a trauma team activation. I’m not going to give you any more information than that.
You’ve got until Monday to figure out what’s doesn’t belong and give me an answer in the comments. I’ll post the full story and answer then.
So what should you do if you encounter a patient that really shouldn’t be driving? First, encourage them and/or their family to self-report. If that fails, familiarize yourself with the laws of your state (or province).
In the US, 11 states have mandatory reporting laws for certain conditions that would impair driving. Forty have some type of reporting system for phsyicians and other health professionals. Many allow anyone to report. However, a few stipulate that they may release your name to the driver or that you must have their permission to report. This is essentially the same as not allowing you to report.
Unfortunately, only 29 states hold you harmless from civil or criminal suit if you choose to report. I suspect it would be a tough sell convincing a jury that a patient’s inconvenience is more important than protecting them from an unsafe driver, though. I doubt such a suit would go anywhere.
So brush up on the laws and procedures in your state and decide what is in your patient’s (and the public’s) best interest. Then do the right thing.
A sample of my compiled report of US state reporting laws is shown below. Click it or this link to download it.
To read Part 1 of this article, click here.
References:
We’ve all taken care of patients that either have a baseline condition or have sustained an injury that renders them unfit to drive. What issues need to be considered with regard to keeping them off the road?
There are a number of ethical and legal considerations. As a physician or other healthcare provider, you have three priorities. In order, they are:
Note that the duty to protect the public supersedes the need to maintain confidentiality. However, if the patient knows that their confidentiality may be violated, they may be less likely to seek treatment, disclose key information, or trust you.
The ideal method of dealing with a driver whom you believe is unsafe is to have a frank discussion with them (and their family, if permitted) regarding why you think they should stop driving and the consequences of failing to do so. They should be encouraged to stop driving voluntarily, or self-report to the license bureau so they can be re-evaluated. It is also very important to encourage the family to support the decision and provide alternative transportation to meet your patient’s needs. Social services should be involved so that transportation alternatives and resources can be provided.
If your patient refuses to surrender their license or self-report for retesting, then you need to consider reporting them to the license bureau yourself. Before doing this you should exhaust all possibility that the patient will stop driving voluntarily. You must also be knowledgeable of your state laws so you know what kind of protections (if any) are given to you after reporting.