BMJ 2004;329:390 (14 August), doi:10.1136/bmj.329.7462.390-a
Filler
A memorable patient
The privilege of wisdom is to listen
A 64 year old patient was referred to the emergency department by an oncology nurse. He had metastatic bronchogenic carcinoma and was complaining of bilateral leg weakness of recent onset. The referral note mentioned the possibility of cord compression secondary to bone metastasis. The patient was seen first by the emergency department doctor, who documented the leg weakness and then forwarded the patient for an orthopaedic review. The orthopaedic team agreed with the diagnosis and arranged hospital admission for urgent magnetic resonance imaging. They also discussed the case over the telephone with me (the on-call physician) regarding palliative management.
Late that night, while reviewing another patient, I overheard one of the student nurses telling her colleague that she had checked the blood sugar levels of the patient admitted with spinal cord compression and that they were very high. Armed with this new information, I reviewed the case history again and this time diagnosed new onset diabetes, precipitated partly by the dexamethasone the patient was taking as a result of his cerebral metastasis. He was discharged after a couple of days.
Since then, I have always paid a little more attention to the discussions of paramedical staff.
Mohammad Imran Khan, consultant in gastroenterology
Wanganui Hospital, New Zealand
We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. Please submit the article on http://submit.bmj.com Permission is needed from the patient or a relative if an identifiable patient is referred to.
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