Question about current medical practice

[shimmergal]

Last week my 10-year-old granddaughter had an accident on the playground. She got a bump on her head and hurt her arm. Initially we were all more concerned about the head bump; the arm was somewhat swollen but she didn't seem to be in much pain. We figured she'd sprained her wrist and she went back to school the next day (Friday). In fact, she even performed in a dance recital over the weekend.

But by Monday her lower arm was still swollen. A trip to the pediatrician followed; then to the diagnostic center for X-rays. It turned out she has a fracture. But, she had to go to an orthopedist to get it taken care of, and the earliest open appointment was Wednesday.

She's just come back from there, with a bright pink cast and a note that she can't take P.E. for the rest of the semester. (She's real happy about the latter!) Plans are for the cast to come off in a month.

Now, unlike a lot of problems people have described here, there's every reason to think this'll turn out OK. Fortunately. It was a simple crack in the bone, no "setting" necessary, and the whole cast-application went speedily. Her parents have good insurance, so hopefully no worries there.

But--we've been talking about how differently this was handled from previous broken bones in the fammily. IOW, why'd she have to wait to get the cast? It seems like this is something any competent doctor could do. Why an extra trip to a specialist, Is it just here, or has medical practice changed so much in the last decade or two? Just wondering; would appreciate input from others.

[bbinacan]

1. CYA

the GP defers to a specialist for fear of being sued if he does it himself. Sad state of affairs.

[Maine_Nurse]

2. Yup, the chances of something going wrong are about...

the same regardless of GP or specialist in a situation like this, but if the GP did it and something did go wrong, he'd be more likely to lose in court (or just pony up a settlement) based on the fact of not being an expert in a specialty. If something went wrong with the ortho doing it, it would be easier to chalk up to the rare incident that nobody could have prevented. Also, casting is sometimes put off to allow swelling to reduce, ensuring a better cast fit.

[bbinacan]

3. Thanks. n/t

[Philippine expat]

4. In a non displaced fracture

they sometimes wait for swelling to go down before they cast.
As far as why a specialist was needed was just a case of CYA.
How many of the previous broken bones were taken to the ER? If she had been
it probably would have been casted there by the on call orthopod.

[SheilaT]

5. Bingo!

When I broke my ankle some years back they waited a week for the swelling to go down to cast. That was a non-displaced spiral fracture. My also being seven and a half months pregnant made it all very . . . . interesting.

More recently I tripped and fell in my driveway at home and had a non-displaced hairline fracture of my right arm just below the elbow. They put me in an ace bandage and gave me a sling. When I came back a week later the doctor gave me a choice: I could be put in a cast, which would adversely affect my quality of life, or I could keep the ace bandage and splint and I had to PROMISE I wouldn't use the arm too much. Naturally I agreed to the latter, although I took off the ace bandage next day because it was making me crazy. I was back to work one week after that, completely healed. Oh and I'm 62 and the ER doctor who took the first x-ray told me I have no sign of bone thinning of any kind.

[mopinko]

6. doctors 'professional' groups, like the department

staff at a hospital draw these bright lines and punish those that cross them. it's about the money.
i learned this lesson when i had home births. the hospital docs were constantly trying to squeeze out the home birth peeps. i nearly bled to death in the crossfire. they play for keeps.

[bemildred]

7. Yep, specialists get paid much better, and some back-scratching occurs,

and hopefully the "care" is not worse, maybe even a bit better.

We did home birth, which came out well, but the politics was unseemly, and the autocratic and judgemental attitude frequently seen in health-care "professionals" on such subjects tells you all you need to know about their real priorities. I suppose spending the first half of your career asshole deep in debt for Doctor training gives them a bad attitude, and in that sense I cannot blame them.