Posted by: Joe | May 15, 2007

A quick message to all the doctors I’ve seen in the past 10 days…

…lean in close, and I’ll use small words so you can understand:

And I’d like to send out a special hands5.gif to the ER doctor I saw last Friday night, who completely dismissed my self-diagnosis of a septal hematoma out of hand. Here’s the play-by-play of my visit to the ENT doctor this afternoon:

Dr: How can I help you today?
Me: I have a septal hematoma as a result of trauma sustained while boxing 2 weeks ago.
Dr: Ok, let’s take a look….why yes, yes you do. Boy, that really should have been taken care of a long time ago.

GAAAAAAAH!!!! What exactly does it say about your medical training when 30minutes of my google-fu can make a correct diagnosis that *FOUR* different doctors couldn’t?

So, instead of a simple needle aspiration or incision and drainage that could have been done in the ER a week ago, I’ll be spending tomorrow morning being prepped for the OR.


OK, now that I’ve got *that* out of my system — check out after the jump for my mini-dissertation on nasal septal hematoma.

The nasal septum is largely comprised of quadrilateral-shaped piece of cartilage that separates the left and right nasal cavities. The septal cartilage is surrounded by perichondrium, a fleshy, fibrous connective tissue. If bleeding occurs between the cartilege and the perichondrium, a hematoma results as seen in the diagram below:


In another portion of the body, a hematoma this small is little cause for concern. However, the septal cartilage depends largely on the blood supplied by the surrounding perichondrium. Separating the perichondrium from the septal cartilage (as can be seen above) can interrupt the blood supply, potentially resulting in resorption of the cartilage and a saddle nose deformity. Luckily in my case, I believe the hematoma is unilateral as seen above, which would limit the degree to which the blood supply to the septal cartilage is compromised. A bilateral septal hematoma, which occurs when the septal cartilage is ruptured allowing blood to seep to the opposing nasal cavity, can result in the cartilage dying in as little as 24 hours.

There is also a very good chance of infection of the hematoma, which can quickly lead to necrosis of the septal cartilage. Luckily in my case, one of the doctors subscribed penicillin for a related symptom.

So, as it turns out, everything is likely going to be fine, but it’s been more good luck than good management on the part of the ER doctors.



  1. Well geez… I’m sure some doctors dismiss the googlers out there because it hurts their big egos that someone with internet access could make the same diagnosis as their many many years of training.

    Hope everything turns out okay!

  2. Doctors get away with everything unless a death or serious life altering injury occurs! The courts have reformed, laws changed etc.. Now, they can get away with being lazy, non caring on and on. All I can say is file complaints on EVERY damn doctor that has treated you badly. It’s easy…go to your state’s Board of Medical Examiners. Since forms can be filled out online so easy/if enough people do it. It severely impairs the Doctor’s ability to practice. I’ve had to do it for a psychiatrist Dr. Alain Katic, here in Texas…he’s got major problems. I’m sure he’ll be a topic in my blog.

  3. you people are such ignorami!

    you don’t realise that a doctor in ER is under IMMENSE pressure, he has many things to do in short time and is overworked… and has more important problems such as people dying to think about- this does not excuse his practise, however you must remember that there is a complex aetiology for any problem, and under these conditions it could easily be missed.

    People are so quick to sue a doctor for any tiny little thing that they do wrong, and they are only making themselves suffer due to defensive medical practice which results in a poorer quality of care, and hinders treatment.

    Moreover, the smallest law suit can result in the end of a doctor’s career- you may justify this to yourself as “he deserved it” but could you truly hold your head up high, when you think of all the good that doctor does too, and whose professional career you have destroyed?!

    Just apply it to yourself… how would you like it?

    This sue-happy culture, and increasing litigousness of society is disgusting, where (straying off topic slightly) any little accident can lead to a person being sued, is horrific- you should be ashamed of yourselves.

    If a doctor is actually dangerous and is going to/has, caused harm to many patients, and is clearly a bad practitioner, then yes, I agree that he should be made to stop practising, but for a small thing, or even a serious one which was just a one off accident- it is just greedy people making money from a man’s career- which by any standards is immoral.

  4. Being an ER doctor is hard. The fact that half your patients are pissed off with you before meeting you doesn’t help. And while they are about halfway done yelling at you about how they want the xray (usually, with no logical reason), Sammy down the hall becomes hypotensive, and then there’s that cardiac arrest which is 2 minutes from arriving.

    Septal hematomas aren’t too mysterious of a diagnosis though…. Grab the otoscope and have a peak.

  5. Doctors do get away with everything!
    Including a serious injury.
    It’s your word against theirs.
    And who do you think the board is going to listen to?
    Doctors can make your life a living hell if they choose to. There really is no place to go when it comes to getting harmed in health care. Physicians have all the power. To bury all their mistakes. I have several health care battle scars. It’s a frightening setting – not mainly because you are sick when you go in. But because you are going into their territory – you’re at their mercy. If they don’t so much as like the way you look, they can make your life very very hard.
    And now they have the laws on their side too!
    Scary indeed.

  6. how long it takes you to boxing again?

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