The Law of Parsimony. Slight-of-Foot.

There is a truism which, when applied in medicine, says that a collection of symptoms (such as cough, fever, and shortness of breath) is usually caused by a single diagnosis (e.g. pneumonia).  The opposite has been true recently at the hospital.  The young child with fever and headache who, on performing a spinal tap to rule out malaria meningitis, has meningitis caused by a bacteria in addition to his malaria.  The young woman with weakness who has typhoid but is also found to have severe anemia.  The many people with HIV or tuberculosis who are subsequently found to suffer from both illnesses.  Your diagnostic efforts are not so much a matter of finding that one illness which explains the person's symptoms, but a matter of continuing your search after each diagnosis is arrived at until you are certain that all serious illnesses which are present have been identified and addressed.  The fortitude of the ill patients we serve is always an inspiration.

I was seeing a young child (about 5 or so) this morning who was admitted a few days ago with severe tuberculosis which had spread throughout his body.  He was placed on medications for his TB.  This morning I was examining him as he did not seem to be getting better as quickly as I would like and happened to notice a blue coloration of his foot.  On closer inspection, he had taken his tuberculosis medication and hidden the tablet between his first and second toe.  I was quite impressed with his ingenuity but still showed his mother who will certainly "encourage" him to take his medication from now on.