Case report: The priority of issues

A young woman, recently married and immigrated to Canada, came to our walk-in clinic with her husband the other day with a very simple request for an injection. Back in India, the 22-year-old woman had been told that she was low in vitamin D and vitamin B12. She had been prescribed B12 injections (two received before coming to Canada), and vitamin D by mouth. She was healthy, with no underlying medical illness, no other medications and no allergies. Since she carried the vial of B12, I drew up and injected her recommended dose.As often happens, she had another question concerning her right arm. Since moving and vey recently furnishing their apartment, she had burned her right forearm several times in the previous two days while using her new toaster (see picture). The scattered burns were not very inflamed (one slightly deeper spot) and having applied an unknown cream from the pharmacy, with no positive or negative results in two days, sought advice on management.The patient’s main concern was not the burns, but the deep brown spots they had produced. She was about to attend social events and wanted the brown spots gone and sought an “anti-brown spot” cream which would work instantaneously. She wondered how long the spots might remain.Unfortunately, given her normal brown skin color, I did not think anything would speed up improvement. In fact, the spots might be very long-lasting. I was sympathetic, and prescribed Fucidin cream to prevent infection, while recommending avoiding sun exposure and wearing long sleeves (despite very hot weather recently) to conceal the rash. I emphasized care in handling the toaster, or any unfamiliar appliance. I gently advised that the brown marks might last for a long time. When fully healed, she could use makeup if desired.Once again, I was surprised at the priority of issues presented for medical attention. She had little life experience and only her new husband (also 22 years old) for support and advice. Our role as physicians often includes a bit of “parenting.”

Case report: The priority of issues

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