BMJ  2004;328:1436 (12 June), doi:10.1136/bmj.328.7453.1436

Filler

Listen to grandmother

They were the two daughters of a couple originally from Pakistan. Their parents had taken them for a visit of several months to see their homeland and renew family ties. On the day after their return to Britain, I was asked to see them because both were feverish and unwell. Their grandmother, who had come back with them, sat in the corner of the room. It was a hot sunny day, and the curtains were drawn for coolness. The grandmother wore a white garment that almost completely covered her.

Both children had bronchitis. I gave a prescription for antibiotics and asked that they be brought to the surgery in a week's time. At the appointment, the father came with the younger child, who was now quite well, but he asked me to see the elder girl urgently as she was very ill.

I called at the house that afternoon. It was another hot day with the curtains drawn, and, as before, the grandmother sat in the shadows. I drew back the curtains to examine the patient, who complained that the light hurt her eyes. I found nothing of note apart from a high fever, but the child was drowsy and clearly unwell. I drew the curtains and sat down by the bed thinking about arranging some investigations. From out of the shadows and beneath the white garments a grating voice said, "She has got typhoid, doctor."

Being a normal, proud, Western physician, my immediate mental response was, "Oh, be quiet, I'm thinking. What do you know about typhoid?" Fortunately, the thought was unspoken and, almost immediately, I reflected, "Well she probably knows quite a lot actually. What do I know about typhoid? Not very much." I racked my brains for anything from the two week course on infectious diseases in my student days and could only remember something about rose spots. I had thoroughly examined the patient twice and had certainly not seen any, but still. I said to the white sheet, "You could be right."

When I got back to the surgery I telephoned the infectious diseases consultant and said that I might have a case of typhoid. He laughed and said, "How many times have I heard that?" He asked me a few questions and finally said, "Oh well, I'll humour you and send out the special ambulance." The next morning he rang to tell me that, yes, she had got typhoid. He sounded impressed.

I had forgotten all about this when, about a year later, I went to an evening meeting on infectious diseases. The lecturer was the same consultant. When he got to typhoid he said how rarely it was diagnosed by general practitioners in Britain even though in some communities it was not uncommon. On the other hand, he quite often got sent patients with a tentative diagnosis of typhoid who certainly didn't have it. In fact, he had only once had a patient referred with a primary diagnosis of typhoid who actually had the disease, and, suddenly pointing at me, he said, "And the medical hero is sitting in this room."

It is always pleasant to receive praise in the presence of one's peers, but I had to confess and tell the story. It was agreed that to the wise saying "Always listen to the patient" should be added "and her grandmother."

Finchampstead

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?