Intended for healthcare professionals

Fillers Thirty one years on

A memorable patient

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1327
  1. Richard Harding, clinical assistant
  1. Bath

“Curmudgeonly, depressed, introspective….” As I glanced through the previous letters about the patient I was about to see in the rheumatology outpatient department I wondered what she would look like. When she came in I was not surprised. She was thin, sallow, and unsmiling. A quick look at the old notes told me that she had rheumatoid arthritis, but repeated comments in the folder implied that the symptoms considerably exceeded the signs.

We began to speak about her arthritis; she had pain everywhere, but when I examined her I was impressed by the normality of her joints. I looked at the fatness of the folder in front of me and began to thumb through it for any clues as …

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