Not thinking of thingsBMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7229.243 (Published 22 January 2000) Cite this as: BMJ 2000;320:243
I was fortunate enough to practise medicine for several years in the Himalayas, and many of my patients were Tibetan refugees, employed by the Indian government on road building and repair. One of my first patients was a man with swollen gums and tender thighs, the latter showing a diffuse dusky discoloration. I was puzzled by this combination, and more with hope than conviction, I gave him some iron tablets. In the evening my pharmacist diplomatically remarked that I might find many Tibetans suffered from scurvy. I took the hint, and had the immense gratification of seeing many similar patients miraculously restored to health by ascorbic acid and dietary advice.
Some years after I returned to England, an elderly man was brought to me complaining of aching in his thighs, which on examination showed a diffuse dusky discoloration. Eventually I referred him to a physician who, to his credit, sent me a letter saying the patient was suffering from scurvy. It seemed that his preferred diet consisted of bread and butter and tea.
The physician had probably seen only a handful of cases of scurvy in his lifetime, whereas I had seen hundreds—but not in England. They say that most mistakes in medicine are made not through ignorance but through not thinking of things.
We welcome articles of 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. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to. We also welcome contributions for “Endpieces,” consisting of quotations of up to 80 words (but most are considerably shorter) from any source, ancient or modern, which have appealed to the reader.