Management of uncertainty

doi:10.1136/bmj.38978.491667.68

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Dee Mangin, senior lecturer1 (derelie.mangin@chmeds.ac.nz)

¹ Department of Public Health and General Practice, Christchurch School of Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand

This patient had adult onset Still's disease with atypical features.1 For general practitioners the presentation of the disease itself is atypical—uncommon enough not to make it on to the initial list of differential diagnoses. The case highlights broader issues around recognition of patterns of illness and dealing with medically unexplained signs and symptoms.1

Pattern recognition

General practitioners often see the pattern of symptoms described at presentation: a young person with a febrile illness, myalgia, and sore throat. This pattern would prompt a working diagnosis of infection, most likely viral. What triggered the general practitioner to recognise that this woman's symptoms deviated from the pattern and raised enough concern to prompt hospital referral? The …