What does the patient want?

BMJ 2003; 327 doi: (Published 27 November 2003) Cite this as: BMJ 2003;327:1295
  1. Liam Farrell, general practitioner
  1. Crossmaglen, County Armagh

    “What made you suspicious, Farrell?”

    Holmes was a trifle unimaginative, but he was a stout fellow and well worth his keep, as the big problem with a meritocracy is that good servants are hard to find; when everybody's somebody, then nobody's anybody.

    “It was the curious incident of the cough in the night,” I said.

    “But the patient did not cough in the night,” said Holmes.

    “Exactly,” I said, “and that was the curious incident.”

    A symptom's absence may sometimes be as telling as its presence. Joe was an almost daily attender, could never leave without a prescription, and had as many symptoms as there are stars in the sky, so when he said he had yet another headache I was not overly concerned. He had nausea and vomiting, yet was the headache worse in the morning and on leaning forward? Of course. Had he double vision? No. And I heard a cock crow three times. For Joe to deny a symptom was as rare as somebody who declares war and actually takes part in it.

    His ears grew longer and even hairier

    After 20 years in practice, I'm hard to shock, so I was only mildly surprised when his skin suddenly turned a bilious green, his ears grew longer and even hairier, and antennae sprouted from his head, all of which actually improved his appearance. “I am an emissary from the planet Zarg,” he said, his voice sibilant and his breath pungent yet noxious, his forked tongue dripping acid saliva on my foot. “Our beloved Emperor Peebo has been most gravely ill for many years and I have long been seeking a physician both wise and intuitive who might provide a cure for this distressing malady. If you succeed you shall be deemed Lord of all Doctors in the Universe and our two peoples shall abide in everlasting friendship.”

    “What are his Majesty's symptoms?” I asked.

    “He has a sore throat and has been bringing up horrible green phlegm.”

    “Gosh, Joe,” I said, “the things you'll do to get an antibiotic.”

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