Lesson of the year

BMJ 1997; 315 doi: (Published 12 July 1997) Cite this as: BMJ 1997;315:133
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

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    The scene is still set in the bustling city of Rhinoceros, verdant and picturesque at the tip of the Potawatomi peninsula. Here we find an abundance of delivered health care, managed care, and even mismanaged care. Here it came to pass that a middle aged woman was sent up to the ward from the emergency room with a diagnosis of confusional state and fractured ribs.

    Confusing indeed was the situation at the bedside, where occasional patients are still being evaluated without the aid of computer generated algorithms and even more rarely (or less interestingly) without the benefit of a multidisciplinary conference. But the woman was in great pain, drowsy from analgesics, the history difficult to disentangle. The intern …

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