Intended for healthcare professionals

Practice Lesson of the week

Secondary drowning in a patient with epilepsy

BMJ 2006; 332 doi: (Published 30 March 2006) Cite this as: BMJ 2006;332:775

general practice diagnosis of secondary drowning

editor- i found the article on secondary drowning in epilepsy very
interesting as my brother-in-law has epilepsy, however, i was a little
perturbed to read the authors' comment, in the penultimate paragraph, that
the diagnosis may have been made by the patient's general practitioner if
the topic were more widely recognised.

i would like to raise the point that secondary drowning would not be
in my list of differential diagnoses in a middle aged patient with
shortness of breath. it is unlikely that the patient will make the
connection and offer a history so how is the GP supposed to?

i would like to know how many times the authors think we see
secondary drowning in general practice. i doubt it would be in the top ten
list of differentials in a medical viva situation either.

i note one author is a medical student, perhaps she will successfully
make the diagnosis when she undertakes her foundation year placement in
general practice.

i would also be interested to hear how often Dr Cohen has seen
secondary drowning during his career. i am sure it is an important
differential in a few very select cases, but it will not be at the
forefront of my mind when i next see a breathless patient.

an interesting case, nevertheless.

Competing interests:
None declared

Competing interests: No competing interests

03 April 2006
rebecca e lewis
salaried GP
dudley beacon and castle pct, union street dudley, dy2 8pp