A tight squeeze

BMJ 2003; 327 doi: (Published 02 October 2003) Cite this as: BMJ 2003;327:817
  1. Brian T Maurer (, paediatric physician assistant
  1. Tariffville, Connecticut, USA

    Although most pathology in paediatrics is psychosocial, once in a while a constellation of clinical signs triggers a dim recollection of something learned long ago. Staring through the glass darkly, you suddenly see the light.

    It was a slow afternoon on a brilliant summer day. A father walked in with his four year old son for an appointment. The only problem was that he had come to the wrong place. Although the boy was our patient, his mother had made an appointment for his physical examination elsewhere, as he needed a physical before starting kindergarten and we couldn't fit him in before then. The office manager said we could squeeze the boy in, and so it was that I saw him after all.

    Our newest and youngest medical assistant took his vital signs and escorted him and his father to an examination room. I recognised the name when I saw the chart. A bit of a tragic situation: the boy and his elder brother had both shown severe behavioural problems at young …

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