Sammanfattning
BACKGROUND – Diagnosis of oral cancer in patients who are dependent on long-term care may be extra challenging due to the presence of chronic diseases, additional functional disabilities and cognitive impairments. This causes dependency of a third party for providing transportation and communication between the patient and the dentist/doctor. Prescribing medicine without prior clinical or paraclinical examination increases the risk of misunderstandings, misdiagnosis, and “doctor’s delay”.
CASE STUDY – A 51 year old male with motor disorders due to cerebral palsy was referred to the Department of Oral and Maxillofacial Surgery, University Hospital of Southern Denmark, Esbjerg due to a persistent painful swelling of his lower right jaw. Three weeks earlier and following a phone call from the patient’s nursing home, the on-call doctor prescribed antibiotic to the patient due to an intraoral swelling. Three days after the on-call doctor’s prescription of antibiotic, the general medical practitioner added an antimycotic drug. Due to lack of drug effect, the general medical practitioner was consulted again. Both prescriptions were repeated in addition to an antiviral medication, still without prior clinical assessment. Following a “doctor’s delay” of approximately three weeks without any medical assessment, the patient was referred by the general medical practitioner on suspicion of oral malignancy due to failing treatment response. On inspection a tumour consistent with an oral squamous cell carcinoma was found.
CONCLUSION – Antibiotics must not be used as a diagnostic tool without prior clinical examination. The use of digital photos e.g. smart phones may support the health care assistant’s contact to the doctor/dentist thus facilitating an easy and swift assessment of the problem. This reduces the risk of “doctor’s delay” and improves the onset of treatment.