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Monday, February 17, 2003The column, however, dealt with a much more serious uncertainty, the diagnosis of rheumatic fever. Rheumatic fever is difficult to diagnosis. There isn’t a blood test for it. It isn’t marked by one distinct symptom or physical sign. Instead, the diagnosis relies on a constellation of symptoms and signs that are backed up by evidence of a recent streptococcal infection. We don’t see it much these days, as the article points out. But, if it’s missed, the consequences can be devastating. In this case, the patient had a lot of risk factors that suggested other causes of inflammed and tender joints, such as gonorrhea. But, nothing panned out, and all that was left was the improbable. Medical diagnosis works this way more than most people realize. There are a few illnesses that announce themselves immediately, but there are many more that require much detective work. As Sherlock Holmes put it, “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” No coincidence that the author of those words was a physician. Sometimes patients grow impatient with the process, and give up before it’s completed. I’ve seen people who have left their doctors in mid-workup with exasperation, not realizing how close they were to having a final answer. All that remains for me in those cases, is to perform the final step. It makes me look unjustly good, but I know that there are an equal number of my own patients who have left me under similar circumstances, and who are singing the praises of someone else for “finally” properly diagnosing them. posted by Sydney on 2/17/2003 06:48:00 AM 0 comments 0 Comments: |
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