WARNING:This letter may contain excessive amounts of information

Note: It might make more sense if you read the previous post before reading this one.

To whom it may concern.
I am writing with respect to recent medical treatment that I have received at the [...] County Hospital in the orthopaedic fracture clinic.
It will be easier if I first explain the circumstances of my visit to the hospital together with the resultant care and diagnosis at which point I will raise my concerns.
On the morning of 11th December I crashed my pedal bike and fell over the front bars breaking my fall with my left hand and resulting in trauma to that arm. Initial symptoms were limited movement, swelling and pain to the elbow. At the time my hand seemed largely unaffected.
I visited the A&E department at circa midday on the 11th. After being examined by an A&E nurse (whom I shall refer to as Person 1) I was sent for x-ray of the elbow (2 were taken). On being re-examined with reference to the x-rays, Person 1 diagnosed effusion of the elbow with displaced fat pad signs and a radial fracture at the elbow. No traumatic injury of the hand was decided upon. Person 1 then arranged for a follow up appointment at the fracture clinic on the 14th December and I was sent home with a sling. Pain relief and anti-inflammatory pills were given. I was very happy with the care and information provided by Person 1 during that visit based on the information available to him at the time.
I returned to the fracture clinic on the 14th and met with Dr. Gajidan (I am fairly sure that I have mis-spelt his name and for this I apologise). I shall refer to him as Person 2. Person 2 showed particular interest in my left hand and did this via a physical examination coupled with the use of an x-ray of that hand. In what was a fairly brief consultation Person 2 diagnosed a suspected fracture of the scaphoid. He also indicated that I had a fracture of the left elbow. Person 2 arranged for me to have a below elbow cast fitted with a follow up appointment on 24th December. No further x-rays were taken.
Later on the day of the 14th it dawned on me that Person 2 had based part of his diagnosis on an x-ray that had not been taken at A&E on the 11th. I recalled the left hand being x-rayed at the [...] Clinic earlier in the year, 27th April to be precise. I was also somewhat concerned that no thumb spica cast had been applied, as my understanding is that it is important to immobilise the thumb when there is a suspected scaphoid fracture so as to reduce the risk of displacement.
Based on these concerns I phoned the fracture clinic on the 24th but unfortunately it had closed. I left a message asking them to contact me on Monday morning. I then phoned the A&E department in an attempt to speak with somebody there but this was denied. I called NHS Direct for advice. They confirmed that a thumb spica cast was normal practice and that I should return to clinic on Monday about this and to confirm the use of an old x-ray.
Come the morning of Monday 17th my elbow and hand were now both heavily bruised and swollen, movement was greatly restricted and the sites were uncomfortable. On returning to the fracture clinic I was told that I would need to book in via A&E a second time before my concerns could be addressed. This I did. It just so happens, that Person 1 examined me again. Person 1 was able to confirm very quickly that the only x-ray the hospital had of my left hand was from a visit to [...] Clinic on 27th April and that the only x-rays from my visit on the 11th December were 2 of my left elbow, neither of which contained images of my hand.
Person 1 then arranged for my cast to be removed and a number of x-rays of my left hand to be taken. These x-rays were reviewed in my absence by another consultant at the hospital, whom I shall refer to as Person 3. Once again I was very happy with the care and information provided by Person 1.
I was informed that Person 3 had diagnosed fractures of both my capitate and scaphoid. I was placed in a second below elbow cast, which once again did not include my thumb. The cast was top arm/back of hand only and did not extend under forearm.
I returned to the hospital on 24th December for my 2nd follow up appointment. I met with Dr. Williams. Based on a physical examination and the x-rays taken on 17th December, Dr. Williams confirmed the radial head fracture and also diagnosed a chip to the little finger side of the wrist, which I understand to be to the triquetral bone. I believe the radial head fracture is of a straight type I. Dr. Williams was adamant that I had not broken either my capitate or scaphoid. I left without a cast and with no follow up appointment. Dr. Williams was very confident in his diagnosis and at the time I was convinced by it. Dr. Willians demonstrated point sensitivity to the triquetral and there appeared to be a displaced fragment on the hand x-ray, he also demonstrated point sensitivity to the radial head and what appeared to be a fracture line on the elbow x-ray.

[At this point in his first draft, Bert wrote:
As an addition please note that my source of income results from manual labour and software writing and I have been a triathlete for the past 15 years as well as being engaged in other physical activities. It is crucial to me therefore blah de blah de blah.
Having stated all of the above there are a number of concerns that I now wish to raise.
OLD XRAY INDICATES SCAPHOID NEW XRAY INDICAES SCAPHOID UhmF

And now I return you to the final version.]

I have been discharged from the hospital.
I am adamant in requiring that the care and treatment I receive results in the very best long-term outcome. This is important on many accounts; I have been a triathlete for the past 15 years and wish to continue in this sport. My income is generated from manual labour coupled with software writing. Any detriment to my hand or arm will severely limit my potential in all of these fields with a resultant negative impact on my future well-being.
Since my visit with Dr. Williams I have become concerned at the differing opinions that have been put forward. Despite Person 2 using information from an old x-ray his diagnosis of a fractured scaphoid was also based on a physical examination. Person 2 came to the same conclusion but felt that the capitate had also been broken. Person 1’s use of an old x-ray also brings into some doubt the diagnosis given back in April. Since my cast has been removed and my hand is now exposed I have been experiencing point sensitivity on the left hand in a location other than the triquetral. This is at the base of the pad on the underside of the hand at the intersection of lines drawn from the thumb and third finger, and is in an area sensitised by Person 1 during his examination.
I do not wish to create additional workload for the NHS but it is imperative that a definitive diagnosis is arrived at. The immediate and effective treatment of a broken wrist is paramount in preventing future medium to long-term detriment including loss of mobility, arthritis or worse. The lack of consistency in diagnosis suggests to me a rather cavalier approach as to what my injuries may be or that there is insufficient information being provided by the x-ray data to arrive at a consistent outcome, this then begs the question as to whether or not other techniques should have been employed.
In conclusion I ask that my injuries be reviewed with immediate effect and, if your consultants cannot reach definitive agreement between them, that further investigation be pursued. Without this I will remain concerned at what the future may hold for me.
This letter has been hand delivered to the hospital and I therefore expect it to be processed quickly. I would be grateful if you would send an acknowledgment of this either by writing to the above address or more preferably making contact by telephone (see above) or via email to [...]. I would also be grateful if you would confirm my injuries in writing once these have been reviewed.
Should I be required to attend the hospital I will be able to do so at short notice.
Yours sincerely,

[Bert]