Listen to the patient

BMJ 2003; 327 doi: (Published 14 August 2003) Cite this as: BMJ 2003;327:401
  1. Bill Kirkup (, public health physician
  1. Public Health Group North East, Department of Health

    The patient was a 79 year old woman with a history of ischaemic heart disease: two acute myocardial infarcts 10 years ago, followed by longstanding atrial fibrillation and worsening angina. Coronary artery bypass surgery six years ago had fully relieved the angina, and she had been free of symptoms (although still with atrial fibrillation) while taking digoxin, β blockers, and warfarin, among other drugs. Now she reported two days of progressive shortness of breath with intermittent pain in the centre of her chest. She had obvious dyspnoea at rest, slight cyanosis, readily audible bilateral crepitations, a raised jugular venous pulse, marked dependent oedema of her arms and legs, and (I was pretty sure) a palpable tender liver.

    We have lost something of the art of medicine in a headlong rush to embrace the science

    It didn't seem the most difficult clinical problem—even for a public health physician without paid clinical responsibilities these last 20 years. I was not the patient's doctor, however, but her son. She had been discharged from an emergency assessment unit in …

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