A memorable patient: Deceived by appearances

BMJ 1997; 314 doi: (Published 18 January 1997) Cite this as: BMJ 1997;314:i
  1. Jacqueline Napier
  1. pharmaceutical physician in west Sussex

    He was only a few years older than me, with a friendly smile. His muscular physique and bronzed complexion were, he told me proudly, the result of a working life spent mainly in the fresh air. It was the second week of my first house job, and he was the first patient on the list for minor day case surgery. I was pleased to see a fit young man–clerking him would be an easy job.

    His medical history was brief; he had rarely consulted a doctor. I chided him on his smoking habit and moved on quickly to the physical examination. His chest was clear, his cardiovascular system normal. His abdomen was firm and difficult to palpate, but …

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