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A practitioner ponders

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I was bitten by a dog last month – quite badly. It was one of those determined, practiced lunges that come without warning. There was even some chewing, and not a glimpse of remorse. It was an elderly dog with a foul mouth brought in by an incompetent owner, and these circumstances only made the situation seem worse.

I was triaged within 10 minutes of arrival at A&E, thus satisfying performance statistics. The decision was eventually made that my wounds merited the attention of a hand trauma specialist at another hospital on the following day.

I began pondering the circumstances of the attack around midnight in bed when the pain relief had begun to subside and I had run out of trial positions for relieving the pressure on my swollen, oozing (and, sadly, dominant) hand.

I was now privy to the knowledge that the dog had previously sent a colleague to hospital in a similar manner. While acknowledging that I had failed to spot this vital information in the clinical notes, I reminded myself that, with appointments running 20 minutes behind, I had probably not made as good a job of reviewing the dog's aggression record as that of its ongoing otitis. I had only myself to blame, because I should have twigged that when the owner took an involuntary step backwards it was for good reason. I couldn't help thinking, however, that if my own dog had bitten a veterinary surgeon and I was watching another one cross the divide into dangerous territory, I really would have said something out loud like, ‘Excuse me, but did you know my dog bit the last…’ or ‘Don't!’

By my fourth day of hospitalisation, I had nothing but admiration for the NHS. A meticulous clinical evaluation was made of every working part of my hand and I underwent two separate investigative operations that discovered and addressed minute quantities of pus in a tendon sheath, debrided damaged tissue and confirmed joint integrity. I received considerate, cheerful and acutely conscientious nursing from both day and night staff.

All this reminded me that, as private medical providers, we owe at least the same meticulous level of care to the pets of our paying clients at all times, especially as veterinary charges seem to be inflating faster than others.

I also received extraordinarily detailed postoperative management and physiotherapy of my hand. Rehabilitation is a relatively embryonic sport in our profession, but something in which I am particularly interested. It was an education to witness such understanding of the complications of inadequate postoperative care and careful coaxing back to full, normal mobility.

After 30-odd years in practice, I have received valuable lessons to audit my pre-examination reading of notes, my thoroughness of clinical examination and the implementation of all possible resources to get the patient back as good as new. It's an ill wind …

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