Management of uncertainty

doi:10.1136/bmj.38978.491667.68

BMJ 2006;333:693 (30 September), doi:10.1136/bmj.38978.491667.68

Commentary

Management of uncertainty

Dee Mangin, senior lecturer¹

¹ Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand derelie.mangin@chmeds.ac.nz

The first 150 words of the full text of this article appear below.

This patient had adult onset Still's disease with atypical features.¹For general practitioners the presentation of the disease itselfis atypical—uncommon enough not to make it on to the initiallist of differential diagnoses. The case highlights broaderissues around recognition of patterns of illness and dealingwith medically unexplained signs and symptoms.¹

Pattern recognition

General practitioners often see the pattern of symptoms describedat presentation: a young person with a febrile illness, myalgia,and sore throat. This pattern would prompt a working diagnosisof infection, most likely viral. What triggered the generalpractitioner to recognise that this woman's symptoms deviatedfrom the pattern and raised enough concern to prompt hospitalreferral? The duration of symptoms was important. There werered herrings, including the overseas travel and the rash inresponse to amoxicillin (increasing suspicion of infectiousmononucleosis).

We can see the complex and subtle nature of pattern recognition,which is the . . . [Full text of this article]