Fillers My most unfortunate mistake

Always double check

BMJ 2000; 321 doi: (Published 16 December 2000) Cite this as: BMJ 2000;321:1510
  1. Lloyd Bradley, senior house officer in medicine
  1. London

    The staff in the accident and emergency department had asked for a medical opinion on the first patient of the evening. Recently arrived from west Africa, the unfortunate young man was struggling to describe his numerous symptoms to his family in French, who were then translating his problems into English. I knew that this was not going to be straightforward.

    Raised voices and increasingly frustrated gestures between the patient and his bewildered uncle and mother indicated that there were other issues at stake besides his fever, lethargy, and joint pains. After exhaustive questioning, I thought that a recent onset of dysuria was, perhaps, relevant in the aetiology of his problems. Although he emphatically denied any recent sexual contact, I wondered if this was more to do with the presence of his family members. Unfortunately, as it was late in the evening, there were no other translators available.

    Sitting in front of the results computer later in the evening, I typed in my enigmatic patient's name and duly noted the normality of the tests that I had requested. As I pondered the differential diagnoses, I scrolled idly back through the results file, looking for any previous investigations. And there it was. Two days ago a urethral swab was sent from the genitourinary medicine department taken from my patient. I clicked on the relevant line to view the result—culture had grown Neisseria gonorrhoeae.

    I returned to the cubicle and asked the patient's mother to wait outside. Through his uncle I asked the patient why he had been to the clinic two days before. He started to get angry, insisting that he had been nowhere near the clinic and that he could not have a sexually transmitted disease. He and his uncle exchanged words, and his uncle then asked if we could speak alone.

    Out in the corridor the uncle explained that it was actually he who had attended the clinic earlier in the week and that he was currently taking antibiotics for gonorrhoea. He and the patient shared the same, albeit unusual, name and it was actually his result that I had seen and mistakenly ascribed to his nephew.

    Having diagnostic information available without a patient's consent carries with it a degree of responsibility to check the accuracy and relevance of the information. Something I shall endeavour to do in future.


    • 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.

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