A case of a twisted ankle.

The patient is 40 and a rather highly strung qualified school teacher who left her job to buy an antique business. She is intermittently separated from her husband (who is not a patient of the practice) and the basic reasons for her marital difficulties are complex and sensitive. Although this may seem rather irrelevant to her present story, it explains why establishing a working doctor-patient relationship has been difficult. The story is that the patient "went over" on her ankle three weeks ago while on a country walk. Her ankle was painful and slightly swollen at the time, and a nurse, who is a neighbour of the patient, applied an Elastoplast strapping. Ability to walk quickly returned, but the top of her foot is still hurting her, and she thinks there is an abnormal bony lump there. Her friend has again applied a strapping and told her she requires an x-ray examination. In addition the nurse-who has worked in the local casualty unit-has told the patient that between five and six is the best time to go, and also advised her to "get your doctor to give you a line." When I examined the foot there was no evidence whatever to suggest that radiography was necessary. No local tenderness was present, there was no swelling, and there was a good, though not yet complete, range of pain-free movement. The dilemma is simple: the patient wants an x-ray examination; her friend who is "experienced" in casualty work has advised her to have one and how to get this done. I am sure she does not need one (physically) but do not want to fall out with her, especially when she has been courteous enough to consult the practice first. What should I have done ?