Intended for healthcare professionals

Filler A memorable patient

The one neither of us saw

BMJ 1999; 318 doi: (Published 05 June 1999) Cite this as: BMJ 1999;318:1552
  1. Anne Seymour, retired consultant in accident and emergency
  1. South Shields.

    It was a long time ago. In those days I was a surgical registrar—I retired three ago—and our colleagues in the laboratory were called laboratory technicians. I had been nine years in Africa, come home and done the fellowship, and was mother of the mess.

    On a Friday morning I was working on the ward when I was called by one of the technicians. “First of all, would you tell the housemen that there is a slide absolutely packed with malarial parasites of Plasmodium falciparum if any of them would like to come and have a look. More urgently I want your advice. I was asked to look at this slide by one of our girls who has never seen malaria outside the classroom slides. It is a patient from Dr X, and when I rang him he said it was all right because he was seeing the patient on Monday.”

    I collected some housemen and we went upstairs to the laboratory while I thought. The technician had spent seven years in east Africa, and I had spent nine in west Africa, so both of us were well aware that the man might quite likely be dead by Monday without treatment. While the juniors looked at the slide I said quietly, “Suppose I ring him up, say you asked me to see the slide and that I am not happy about it, and that I think we should refer the patient to the tropical diseases hospital for another slide?”

    So that was what we did, having rung the hospital to let them know the man was coming. He made a good recovery and called in later to thank us. Neither the laboratory technician nor I were brave enough to tell the consultant surgeon for whom I worked, or the consultant in charge of the laboratory, what we had done. We had taken refuge in what Donald Berwick calls “mitigated communication,” so while we had ensured the safety of that particular patient, the chance of teaching the general practitioner was missed.1 What happened to the next patient he had with malaria I do not know. The general practitioner and his defence organisation never realised what a narrow escape they had had.


    We welcome articles up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake,or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an identifiable patient is referred to.


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