A Piece of My Mind
August 8, 2012


Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.

Author Affiliations: University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden (Mr Rafelson; rafelswm@umdnj.edu); and Cooper Medical School of Rowan University, Camden (Dr Rajput).

JAMA. 2012;308(6):579-580. doi:10.1001/jama.2012.8727

La herida was the chief complaint—the wound.

A 51-year-old man named Manuel walked into our student-run clinic to get his wound healed. It was a small, necrotic, ulcerative lesion, almost resembling dry gangrene, on an upper extremity. It was nontender. He attributed it to an injury at work two years ago, but wasn't sure if that was the cause. His medical history was unremarkable: no diabetes, hypertension, smoking, or dyslipidemia. He had strong peripheral pulses. Something seemed off about this case. He had visited the emergency department several times before, but was always discharged with instructions to see a specialist. He tried to make a surgery appointment a year ago, but the office didn't accept charity care. My preceptor and I then saw the patient together. She explained that this was likely a chronic, nonhealing wound. The patient needed a surgery consult, not another ED visit.