Grand rounds

It's the Friday lunchtime grand round, and I am presenting. The cardiologist stands up to introduce me: “Today we are going to tell you about a very interesting and unusual case, and I want you to shout out the diagnosis when you've got it. It's about a 46 year old man who first presented to us…” Someone shouts out from the floor: “Atrial myxoma.” Game over. Or was it?

Grand rounds have changed a lot in recent years. They used to be about patients with rare diseases who presented in an unusual way (a man with Whipple's disease who had a pyrexia of unknown origin). Progress brought us patients with rare diseases who had typical symptoms (a 30 year old woman with uncontrolled hypertension who had a phaeochromocytoma) and then patients with common diseases who presented in an unusual way (a 40 year old man with coeliac disease who had a myopathy).

And what's their future? Increasingly we will hear about patients with common diseases who have typical symptoms. Why shouldn't we? …