Help Me, Help You

As doctor's, we are only as good as the information that we get.
In large part, we depend upon the patient's account of what symptoms have led them to seek medical care. Certainly our clarifying questions or 'review of systems' can help guide the story-telling, but we are still at the mercy of memory and point of view.

Today I saw a quirky but pleasant woman that I have taken care of on two separate occasions. She is on blood thinners right now because of a clot that broke off and went to her lungs a few months ago, and her levels have been difficult to control. Her blood is so thin that she has already had some internal bleeding in her left lower leg. She came in to follow up about that, but also mentioned that she had 'new bumps on her stomach'.
"Hmmm...how long have they been there?"
"Since yesterday. They hurt a lot if I press on them."
I examined her stomach, and sure enough there were palpable nodules underneath the skin. They felt like hematomas (bruises) and there was some overlying bruising to the skin. Knowing that she has super thin blood right now, and that any mild trauma to the area cold have produced these symptoms, I set about trying to determine the cause. I would feel a lot better about the situtation if I knew the bleeding into her stomach wall hadn't happened spontaneously.
"Can you think of any trauma to this area yesterday?"
"Uhh...no."
"Nothing, nothing you walked into, nobody bumped into you, etc., etc.,"
"No, nothing."
"Well that's odd."
We kept talking and a minute or two later, while talking about something else, she offhandedly mentioned, "By the way, I got into a car accident yesterday with my brother."

pause.

"Any chance you were wearing a seatbelt?"
"Yeah, I was."
"Any chance the seat belt was sitting right over this bruised portion of your lower abdomen?"
"Yeah, come to think of it, it was."
"And the bumps showed up after that?"
"Yeah, they did."

Huh.

________________________________________________________________________________

"Give me the straight scoop, people! And don't tell me the bow makes it hard to take me seriously!"