Minerva
BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39471.433785.47 (Published 31 January 2008) Cite this as: BMJ 2008;336:284All rapid responses
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Oh dear! Notwithstanding the risk of impeding the progress of a new
or rediscovered medical condition, one with proposed hazardous surgery, no
less: I have to say that this notion is plain wrong, as I won't get away
with writing the word ending in '..ocks'.
Professor Southall's travails have illustrated the risks of
commenting upon patients one has never seen, but I think it very likely
that a history of 'feeling a lump in the throat' could be elicited from
this patient. Sadly, the BMJ site includes the possibility of creating a
'PowerPoint Slide for Teaching'from this report, but I fear that this
disease mongering could disseminate like a virus. Prompt immunisation is
indicated.
The Little Grey Cells should have been alerted by the multi-year
history, and the intermittent nature. They should have been further
prompted to stay the keyboard finger of the enthusiastic reporter by the
knowledge that the oesophagus lies anterior to the cervical spine in
everyone, and a lot of elderly people have much larger osteophytes than
this measly example; an awful lot of operations fortunately do not happen.
Co-incidence is not causality.
Competing interests:
I am a swallowing video-fluoroscopy radiologist
Competing interests: No competing interests
Author's Response to Stevenson
I would like to thank Dr Stevenson for his interest in my article,
and I defer to his greater experience in interpreting barium swallow
examinations. I have read his comments with interests, but would like to
make a couple of points in response.
Patients are a funny breed and their symptoms rarely conform to a
textbook definition or to their doctors' expectations. I have no doubt
that there may many people with larger osteophytes than this lady who are
free of symptoms, dysphagia or otherwise; however, I am equally certain
that there are many people whose symptoms seem out of proportion to
radiologically modest signs.
A consultant of mine passed on a gem of knowledge to me the other
day, which I think is appropriate to this discussion: if it has four legs,
a tail, smells, and goes "Moo!", then it is probably a cow. Coincidence
may not be causality, but with her food sticking just below her cricoid
cartilage, at the approximate level of the offending osteophyte, the
coincidence starts to seems rather large.
When can we ever be 100% sure that we have the right answer? Medical
practice is rarely black and white (unlike cows), and if other common or
serious causes of the lady's dysphagia have been excluded, is it not fair
to assume that this cow is the root of her problems?
Competing interests:
None declared
Competing interests: No competing interests