Unwell

Request form (note I created this myself to protect the identity of the patient and the referring medical practitioner).

Request form (note I created this myself to protect the identity of the patient and the referring medical practitioner).

<facetiousness> <sarcasm>

You’ll notice I’m using facetiousness and sarcasm tags for this post.

One of the things pathologists discuss from time to time is the importance of clinical context and the provision of relevant clinical information on referrals.

More often than not the clinical information section on a referral form that accompanies a pathology specimen from patient to pathologist is blank.

We “rejoice” when we read something is there and get excited when the information is relevant. For example, if we get a urine specimen and the referring doctor writes the patient has had lower abdominal pain passing urine (dysuria) for a few days and the patient has a fever (febrile). This is what we’d appreciate. This description classically suggests cystitis especially in a woman.

The other day I was reviewing results of patients who had been referred and a blood specimen had been submitted for culture (blood cultures). On one patient the bottles had just signalled, the wet preparation revealed slowly motile bacilli and the Gram’s stain revealed Gram-negative bacilli. I reviewed the referral form (request form) and was disappointed to read “unwell”.

A medical practitioner had completed this referral form. This person had completed medical school, I’m assuming the referring doctor was a junior house officer. The point is this person would have received a few years of clinical training. Training involving how to collect a relevant medical history and perform a clinical examination. What did we get from years of taxpayer money? “unwell”!

I called the relevant ward and asked to speak with the doctor looking after the patient.

The patient was an older man. He had loin pain and fever. His urine specimen had revealed pus and blood (pyruria and hæmaturia). This patient had bacteria in his blood (bacteræmia) because of a urinary tract infection (UTI). All UTIs in men are serious and require further investigation. Sure he was “unwell”. He was seriously unwell!

</facetiousness> </sarcasm>

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