The door handle sign

doi:10.1136/bmj.328.7449.1187

BMJ 2004;328:1187 (15 May), doi:10.1136/bmj.328.7449.1187

Filler

The door handle sign

She had been to see me several times during the previous fewmonths with a variety of minor and seemingly insignificant symptoms.This occasion was no different; she had a minor degree of halluxvalgus, a runny nose, and some contact dermatitis on her wrist.She was, however, clearly very unhappy, but I could not discoveran underlying cause. After a long and unsatisfactory consultation,she left my consulting room leaving me aware that I had failedto meet her need. Fortunately, as she closed the door behindher, I noticed that the handle continued to turn unnecessarilytwo or three times.

I followed her into the by now crowded waiting room and askedher to come back. "I think there is something you haven't toldme," I said. Immediately she burst into tears and started toundo her dress. Her chest was swathed in purulent bandages,which covered a gangrenous breast carcinoma en cuirasse.

The relief was immediate and enormous. I don't know how shehad managed to conceal this from her husband for so long. Idon't think my failure to make a full examination on her firstvisit would have altered the prognosis, but it was a salutarylesson not to write off every seeming hypochondriac. Despitethe dire situation, my subsequent consultations and visits werevery rewarding.

John Williams, retired palliative medicine physician

St Austell