31 October 2011

Power of deduction

One professor told us that entering the medical profession would make people see us differently. Another told us the corollary: that entering the medical profession would make us see people differently. I can already feel it happening.

Twice today I noticed a person whose gait was abnormal. Automatically I tried to classify the abnormality and predict what underlying disease it might signify.

One swung one of his legs out in a semi-circle, a type of gait called hemiparesis ("weakness of one side of the body"). It often is a result of stroke:

The other took short, halting steps that seemed to require tremendous effort to lift the leg off of the ground. This appeared to be bilateral steppage gait, a high-stepped gait typical of disease of peripheral nerve conduction, such as Charcot-Marie-Tooth disease or amyotrophic lateral sclerosis:

[More on gait abnormalities at Stanford 25, a Stanford initiative to increase medicine's emphasis on physical diagnosis.]

It is amazing what can be deduced from studying someone's gait and general appearance. Sapira's, my favorite book on physical diagnosis, reminds the reader that a clinician's examination of a patient begins the moment he opens the door to the exam room.

An English physician, Arthur Conan Doyle, was taken by the outstanding powers of observation of one of his professors, Dr. Joseph Bell. Doyle later became an author, and Bell became the basis for Doyle's celebrated detective, Sherlock Holmes.