BMJ 1996; 313 doi: (Published 23 November 1996) Cite this as: BMJ 1996;313:1323
  1. A Marshall Barr

    At least I knew he was ill

    In 1960, two years after qualifying, I joined my father's general practice in Perth, Western Australia. Soon afterwards, wrongly assessing my level of competence, he took my mother off on their first trip to Europe and left me to it. Of the many interesting patients in his singlehanded practice, several were ex-servicemen who had suffered badly in Japanese prisoner of war camps. As well as their emotional and physical scars, some still had odd tropical diseases, which had been demonstrated to me during my student years. One of these men came into the morning surgery looking sallow and unwell. For a week, he said, he had felt tired, with a pain in the “top of me gut, Doc.” He had a tachycardia, a temperature just above normal, and most certainly a large tender liver. He also had a history of amoebic dysentery.

    I telephoned Bruce Hunt, a splendid physician and himself a medical hero of the prisoner of war camps, to say that I had a probable case of amoebic liver abscess. “OK, son, send him in and I'll take a look.” An hour later, he telephoned back. “Shall I summarise the main physical findings? He has atrial fibrillation at about 130/minute; the jugular venous pressure is raised four finger breadths; he has moderate ankle oedema; the liver, as you say, is enlarged and tender.”

    I was not only mortified, but astounded. The only cases I had seen with acute cardiac failure had all been in bed in hospital. No one had told me that such patients could walk into a consulting room. I stammered out my apologies. “Don't worry, son,” said Bruce, “at least you recognised that he was ill.”—A MARSHALL BARR is a retired consultant anaesthetist in Reading

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