Look and learn still holds true

Issue: BCMJ, vol. 60, No. 8, October 2018, Page 391 Letters

The article in the July/August 2018 issue of the journal about assessments by pit appointment [2018;60:304-313] reminded me of the dom appointments I took part in, in UK general practice. No, not that kind of dom, but the domiciliary visit. A specialist consultant and the family doctor would meet at a patient’s house. The fields covered included internal medicine and especially psychiatry. These visits were very popular with all concerned, especially with the specialist, who was extremely well paid for this service. Some of the lessons from these visits have stuck with me all my long professional life. An illustrative case follows.

A late-middle-aged accountant suddenly changes his behavior. Previously his routine was immutable. He took the same train in from his small village to his firm in the city of Birmingham every day for years. Suddenly, changes occurred. He began stealing women’s underwear from washing lines and planning grandiose holidays and world tours. Naturally, his wife was worried and, as was the fashion then, called the village constable, who, instead of locking him up, called the doctor.

As a junior in the practice I was delegated to meet the psychiatrist on a domiciliary visit. We found a gregarious, garrulous, excitable but very happy chap. A short history disclosed the sudden and dramatic change in behavior in a man who had never been mentally ill in his life and had no family history of mental illness. “What was your impression?” the psychiatrist asked me. “Hypomania,” I replied. “True,” he said, “but look at his fingers.” They were heavily nicotine stained and gave the suggestion of clubbing. Several months later he died from lung cancer. The possibility of paraneoplastic syndromes presenting as mental illness has been a lifelong lesson. “Look at and learn from the patient” was promoted by Osler and remains as true today as it was over 100 years ago.

Having a specialist and the family doctor meet the patient had obvious advantages. Perhaps as our health system evolves we could revive some of these ancient practices?
—Ralph Jones, MD

This letter was submitted in response to “Assessment by pit appointment as an alternative to full psychiatric consultation.”

Ralph Jones, MD. Look and learn still holds true. BCMJ, Vol. 60, No. 8, October, 2018, Page(s) 391 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply