The Home School Court Report
VOLUME XXI, NUMBER 3
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May / June 2005


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  MEDICAL ADVICE FROM DR. SAYRE  

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DOC'S DIGEST

The rest of the story

As a patient, one of your most important responsibilities is to provide your physician with an accurate medical history.

Recently a 15-year-old male patient was brought in with a complaint of a lump on his shin. He stated that it had been there "a long time" and was getting bigger. The area was painful, especially with running and direct palpation. With his family history of leukemia, I was concerned about the possibility of some sort of malignancy. I quizzed him specifically regarding any possible trauma to the area, as well as the duration of the symptoms. He could not recall any injuries to the lower leg, and was pretty sure that it had been about two months since the onset of the discomfort.

In considering my options, I decided to start simple and get a plain x-ray of the tibia. The radiologist commented on visible soft tissue swelling and periosteal findings compatible with a bone bruise (the periosteum is the covering of the bone). Armed with this information, I discussed the situation with the patient's mother. She recalled seeing him nearly fall off the trampoline about two weeks before I initially evaluated him, catching his leg between the trampoline and the frame. He did not complain about this injury, probably partly because his parents had made the comment that if anyone broke a bone on the trampoline, the trampoline was "history."

I talked directly to the young man and pressed him further. "When exactly did the symptoms start?" Well, in retrospect, we discovered that on the family vacation three weeks ago, the boy had not complained of leg pain despite standing for long periods of time at an amusement park. The trampoline incident had occurred after the family's return. The boy admitted that maybe it had been only a couple of weeks, and in fact it was a little less painful in comparison to several days prior. Since all he was suffering was a bruised bone, I was certainly glad I had not ordered a $2,000 MRI of the leg!

It is so important to give your physician an accurate history of your symptoms. Not only does it become part of a permanent record, but your doctor's choice of further workup or treatment will likely be based on the history you provide. Ultimately your life (or your child's life) may depend on the accuracy of your words.


About the author

An HSLDA board member since 1997, Dr. Rodger Sayre is a family physician, and his wife Mary is a registered nurse. They live in Tunkhannock, Pennsylvania, and teach their 11 children at home. Dr. Sayre received his medical degree from Thomas Jefferson University in Philadelphia and maintains board certification in Family Practice. A Geisinger Medical Group associate with a busy practice in Nicholson, Pennsylvania, he is a member of the Christian Medical Association, the American Academy of Family Physicians, and the American College of Sports Medicine.