Jerome Groopman is discussed again over at DB's Medical Rants. I'm sure just about all of you know of Groopman and his book, How Doctors Think. This book, which discusses how MDs go about their business of making, or missing diagnoses, was the talk of the blogosphere when it first came out in 2007 and seems to pop up regularly since. I must admit, while the book was an interesting read, his chapter on his own wrist problem lead me wonder exactly how Groopman thinks.
His wrist problem is discussed in mechanical terms, with multiple small traumas, but the problem evolved to the point where it would regularly become "hot, beet red, and swollen". Now this is the classic triad of inflammatory joint pain, generally seen in arthritic, not orthopaedic conditions. I would have to think of crystal arthropathy like pseudogout or gout, maybe even palindromic rheumatism. Instead, it seems like Groopman visits half the orthopedic surgeons on the East coast and discovers, to the surprise of exactly nobody, that surgeons, when they aren't sure what to do, like to operate. Although the man is an internist, there is no mention of visiting one of his rheumatology buddies who might have done the appropriate diagnostic procedure, which is a simple joint tap during an attack.
Sure, maybe it was mechanical, as he suggests by chapters end, but with those symptoms he might have avoided a lot of grief by staying in the internal medicine wing of the hospital. For all I know, he's still suffering from pseudogout with an underlying metabolic disease like hemochromatosis. Just hope he takes the walk down the corridor to his local rheumatologist.