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Views And Reviews Primary Colour

Helen Salisbury: The gaps in our knowledge

BMJ 2020; 368 doi: (Published 21 January 2020) Cite this as: BMJ 2020;368:m161
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

At medical school we learn to recognise the patterns of symptoms and physical signs that add up to predefined diagnoses. They appear in the textbooks and again in exam scenarios, but many of the real patients we meet in the clinic don’t fit neatly into diagnostic boxes. Sometimes they’re just variants on a theme (the pneumonia without a cough, the painless heart attack), but a sizeable minority of patients in both primary and secondary care have symptoms we can’t explain. Estimates vary, but this is said to be a feature of …

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