My Greatest Mistake

Skoda's fool

BMJ 2004; 329 doi: (Published 16 December 2004) Cite this as: BMJ 2004;329:1494
  1. D L Sackett, director (sackett{at}
  1. 1 Trout Research and Education Centre at Irish Lake, Canada

    As the solo intern in charge of a Chicago emergency room one August night in 1960, I was grappling with three dozen former passengers (by then, aspiring personal injury claimants) of a city bus involved in a minor collision. Most had demanded x rays in hope of fracture, and groaned to potential witnesses as they limped about the emergency room.

    Into this cacophony descended a thirty-ish scrub woman who said she'd developed a non-productive cough and increasing shortness of breath over the previous two weeks. She wouldn't wait for blood work or a chest film, so I conducted a quick exam in a noisy cubicle. All I found were hyper-resonance to percussion over her upper lung fields and an evanescent wheeze. I prescribed the contemporaneous asthma regimen, arranged a follow up appointment in the medical clinic, and promptly forgot about her…… until she was presented at grand medical rounds six weeks later as an interesting patient whose lymphoma had presented as bilateral pleural effusions. When she described being told by a doctor in the emergency room that she had asthma, the audience snickered in derision, I froze in mortification, and the physician in chief did three remarkable things: he didn't call me out of the audience to chastise me before my peers and betters; he took me aside after the round, both to discuss my error and to teach me about “Skodatic resonance” above pleural effusions; and he didn't hold my dumb mistake against me, but became my mentor during my first residency in internal medicine.


    • Competing interests See

    • True confessions

      In October Minerva asked readers to submit their tales of clinical, career, or other mistakes, for publication in this issue. First to respond were Dave Sackett and Richard Smith, followed by others, some of whose confessions are printed below. You can see all the responses and add your own contribution on (

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