Word association: hepatitis, eh?BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7253.87/a (Published 08 July 2000) Cite this as: BMJ 2000;321:87
“Hello, it's Dr Riley here,” said the friendly public health consultant, asking for some background to our patient's diagnosis of hepatitis A. The health board's press office had sought Dr Riley's advice, having been contacted by the local authority, fortunately before it wrote to the parents of every child at a primary school in a nearby affluent area because of Mrs McB's illness. She was a teacher. Closure of the school seemed a little excessive to Dr Riley and to me.
The notes read, “Tel: hepatitis. C.14,” dated two days before. My partner's note signified that the patient had telephoned asking for a certificate, telling him that she had hepatitis. The previous entry was by another partner, who had seen her five days before regarding abnormal liver function tests. The outcome of that consultation was a referral to a surgeon for investigation. I guessed, in fact wrongly, that the patient had not yet been seen by a surgeon and I promised to make inquiries.
Mrs McB had been seen urgently in the surgical outpatient department and had telephoned the surgery the next day to ask about the wisdom of going to work, saying that she'd been told that the most likely diagnosis was hepatitis. My partner had said that there were numerous causes of hepatitis, some of which were viral infections, and provided the certificate.
The word “hepatitis” was immediately associated by the education authority with epidemic hepatitis A. Moves were afoot that might close the school, and a press release was being prepared, hence Dr Riley's involvement. He telephoned later that afternoon, the crisis averted, to tell me that as yet no blood samples had been tested for hepatitis A, B, C, or other, and that as he'd suspected it had all been a storm in a teacup. That storm had so far touched two consultants, three general practitioners, a receptionist, a health board press offficer, a local authority, a school, and very nearly hundreds, perhaps thousands more.
As it happened no children missed schooling, no press reporters had a field day, no serology laboratories were overloaded, no surgery telephones overheated, no world experts in hepatitis were decorated, no water authority's shares plummeted, no farmers whose cattle had inadvertently lived nearby were victimised, and Mrs McB didn't have infectious hepatitis.
What we say, write, and mean is frequently misunderstood, misinterpreted, and misassociated. We get used to it but most often don't realise that it has happened. This instance almost led to public alarm. We as doctors must attempt to avoid ambiguous terms.
Sadly, Mrs McB had metastatic breast cancer and has since died. She is very much missed by her family, pupils, and colleagues.
I would like to thank Dr Riley.