The Subungal Hematoma Lesson

A young man, accompanied with his father, consulted Dr. Dev (Fictional name) at his clinic. He was in great pain. The young man had accidentally hit his thumb with a hammer, leading to subungal hematoma (Painful Blue Nail).

In this condition, due to some forceful injury, the tiny blood vessels below the nails get ruptured, leading to leakage of blood between the nail bed and the nail. The accumulation of blood in the limited place causes great pain. You can imagine someone tearing your nail from your finger with pliers to get an idea about the intensity of the pain.

Drainage of the collected blood leads to rapid relief in pain. The conventional technique is to give local anesthesia with injection around the thumb base, and cut a piece of nail to give a path to the blood to drain out.

Dr. Dev had read a simple solution in one of the American surgical manual. In this the doctor simply straighten out a paper clip, heat its one end on flame and apply the heated end to the center of the nail over the hematoma (collected blood). Due to heat, the nail gets melted, creating a small hole, through which the blood drains out. Also, the flame destroys any bacteria over the clip.

Dr. Dev thought of applying this simple and instant solution, instead of subjecting the patient to lengthy procedure.

After cleaning the patient’s hand and thumb with an antiseptic solution, he picked up a paper clip lying on his desk and straightened it. The patient and his father looked at Dr. Dev suspiciously.

Then he asked his assistant to heat and bring it. The suspicious looks now were added with a worried looks. Dr. Dev, unaware of this, applied the heated end of the paper clip to the nail. Due to process of heating it in another room and bring it, the temperature of the clip has decreased and it required 2 more trips.

With each trip, the look of suspicion and worry deepened on the father and patient’s face, whether they have come to a quack or a surgeon.

Finally a big enough opening was created in the nail and the blood drained out. With the draining of blood, the pain of the patient decreased, giving him instant relief.

Dr. Dev applied a dressing over the opening to absorb more blood, prescribed some analgesics and antibiotic and asked to patient to review with him after 48 hours. Due to simplicity of the procedure he just charged Rs. 100 (approx. 1.5 US dollar).

As the patient and his father were leaving, they could not hide their misgivings and distrust and asked, Dr. Dev, ‘Doctor, if I had consulted you in the hospital, would you have used a paper clip there also, instead of proper instruments?’ 

Dr. Dev effort to explain that this method is from a famous American Surgical textbook was met with disbelief.

Dr. Dev learnt his lesson.

Next time, a patient of subungal hematoma came to him, he took him to the hospital to which he was affiliated.

In the minor OT (operation theater) of the hospital, he cleaned the patient’s hand and thumb with antiseptic solution, wrapped it in sterile operation towels, and using a surgical blade drilled a hole in the center of the nail over the hematoma to drain it. The charge of the procedure now was Rs. 1000 (approx 15 US dollar).

Result: Happy Patient, Happy Doctor and Happy Hospital Management.

Practice of medicine has in part become showmanship. The patient’s tendency to get impressed by unnecessary showmanship and distrust towards simple treatment is also responsible for it. Cheaper and more affordable care will result if patients start using their head instead of heart and evaluate the end results objectively.

(Based on true incident)
— NKD

© Author. All rights reserved. 

Similar Article on Use of Costly Drugs at: http://agnipathdoctors.blogspot.com/2015/04/practice-tip-use-of-costly-drugs.html

DISCLAIMER: This article is intended only for fun purpose. The author does not promote or recommend any behavior illustrated here or claim it to be useful. Use of the information herein is at you one's own risk. Before trying to emulate or follow anything the reader is well advised to take into account ethical, moral, legal and other considerations. The author recommends that Medical Practice should be of the highest ethical and moral level keeping in mind the interest of the patient as foremost. 


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