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Failure to Cancel Tests: A Case of an Unnecessary Joint Arthrocentesis

Failure to Cancel Tests: A Case of an Unnecessary Joint Arthrocentesis Opinion LESS IS MORE TEACHABLE MOMENT Failure to Cancel Tests: A Case of an Unnecessary Joint Arthrocentesis A Teachable Moment Story From the Front Lines ees often order investigations preemptively owing to Amanda E. Goldberg, MD An elderly woman with a history of choledocholithia- time pressures on call and their desire to demonstrate Department of sis presented to the emergency department with a thoroughnessintheirclinicaldecision-making. Whenour Medicine, University 3-day history of nausea and abdominal pain. She was patient developed acute monoarthritis, her medical his- of Toronto, Toronto, admitted to the general internal medicine (GIM) ser- tory, physical examination, and radiographic images Canada. vice with a diagnosis of recurrent biliary obstruction alone were sufficient to make the diagnosis of pseudo- Abi Vijenthira, MD due to microlithiasis. She underwent an endoscopic gout and exclude the possibility of septic arthritis. How- Department of retrograde cholangiopancreatogram (ERCP) 2 days ever, the on-call trainee preemptively ordered wrist ul- Medicine, University later (on a Friday), which was unsuccessful at cannu- trasonography as well. This could have been avoided by of Toronto, Toronto, lizing the common bile duct. Plans were made for a reviewing the results of the radiograph overnight with Canada. percutaneous biliary drain insertion and http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Internal Medicine American Medical Association

Failure to Cancel Tests: A Case of an Unnecessary Joint Arthrocentesis

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Publisher
American Medical Association
Copyright
Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6106
eISSN
2168-6114
DOI
10.1001/jamainternmed.2015.0632
pmid
25844992
Publisher site
See Article on Publisher Site

Abstract

Opinion LESS IS MORE TEACHABLE MOMENT Failure to Cancel Tests: A Case of an Unnecessary Joint Arthrocentesis A Teachable Moment Story From the Front Lines ees often order investigations preemptively owing to Amanda E. Goldberg, MD An elderly woman with a history of choledocholithia- time pressures on call and their desire to demonstrate Department of sis presented to the emergency department with a thoroughnessintheirclinicaldecision-making. Whenour Medicine, University 3-day history of nausea and abdominal pain. She was patient developed acute monoarthritis, her medical his- of Toronto, Toronto, admitted to the general internal medicine (GIM) ser- tory, physical examination, and radiographic images Canada. vice with a diagnosis of recurrent biliary obstruction alone were sufficient to make the diagnosis of pseudo- Abi Vijenthira, MD due to microlithiasis. She underwent an endoscopic gout and exclude the possibility of septic arthritis. How- Department of retrograde cholangiopancreatogram (ERCP) 2 days ever, the on-call trainee preemptively ordered wrist ul- Medicine, University later (on a Friday), which was unsuccessful at cannu- trasonography as well. This could have been avoided by of Toronto, Toronto, lizing the common bile duct. Plans were made for a reviewing the results of the radiograph overnight with Canada. percutaneous biliary drain insertion and

Journal

JAMA Internal MedicineAmerican Medical Association

Published: Jun 1, 2015

References