Have realistic expectations about medical care

I see patients with upper abdominal pain on a daily basis. While the common causes include gastritis and gallstones, it could sometimes be caused by acute appendicitis.

Patients with acute appendicitis often complain of upper abdominal pain on day 1 of presentation, which then shifts to the right lower quadrant over a period of one to three days.

By the time the pain has shifted to the right lower quadrant, which is often accompanied by severe pain, nausea and fever, diagnosis could be made easily.

Among my patients with acute appendicitis, some complain about their family doctor, whom they consulted on day 1 of the pain, missing the diagnosis in the beginning (1,000 docs petition to revoke paediatrician's suspension; July 13).

I would always explain that although acute appendicitis could present with upper abdominal pain, up to a hundred medical conditions could also do the same.

This is not medical negligence, nor misdiagnosis. This is just the natural history of the disease.

It would be unrealistic and impossible to expect any doctor to diagnose all cases of acute appendicitis on day 1 of presentation.

Diagnosis of appendicitis could be made early in some cases by doing a contrast enhanced CT scan. But doing a CT scan for every patient with upper abdominal pain would be wrong practice of medicine, with explosive costs and with unnecessary radiation exposure to patients.

Proper management would be continual evaluation and to do further tests, such as a CT scan, if the situation does not improve.

While it is understandable for the public to expect prompt and accurate diagnosis when they fall sick, the public ought to have reasonable and realistic expectations about medical care.

Desmond Wai (Dr)