“Misdiagnosing patients’ preferences may be less obvious than misdiagnosing disease, but the consequences for the patient can be just as severe”, states a new publication from the Kings Fund – Patients’ preferences matter: stop the silent misdiagnosis.

The author, Al Mulley, argues that well informed patients make different choices about their treatment. Also, patients’ may want different things to their doctors and there are big differences across different geographical areas.

How to address these important preferences is challenging in a busy clinical practice. It is easy to make assumptions about what another person would prefer. In medicine we often feel we act in the patient’s best interests but when was the last time we had the opportunity to really explore the implications of a certain decision, or plan ahead with a patient to future events to help shape their care?

This is a useful paper, freely available to download, that offers some suggestions for how health care systems can avoid the erroneous preference diagnosis.

The kneeling delivery of a child is pictured on a piece of Tumaco-La Tolita pottery from South America crafted 2000 years ago. What can we learn from these pre-Columbian Indians?

Seema Biswas
Editor-in-Chief

Kneeling delivery in America 2000 years ago

Here are two cases of hypokalaemic quadriparesis complicating Dengue fever in India. The authors discuss the neurological complications arising from this virus transmitted by mosquitoes in the sub-tropical regions of the world where over 2.5 billion people (two fifths of the world’s population) are at risk.

Seema Biswas
Editor-in-Chief

Acute hypokalaemic quadriparesis in dengue fever

Here an 87 year old lady with an abdominal mass present for 20 years presents with sepsis and vaginal discharge in Spain. With the help of some eye-catching images the authors discuss the aetiology and natural history of pyometrium.

Seema Biswas
Editor-in-Chief

An elderly woman with Prevotella bacteraemia secondary to pyometrium

A 21 year old man returns from India agitated, confused and nearly unconscious. He is intubated and empirically treated for bacterial meningitis and viral encephalitis. Three days later, with no improvement, intravenous quinine is started and the patient begins to recover…

The medical challenges of global travel…

Seema Biswas
Editor-in-Chief

PCR negative cerebral malaria in a traveller returning from Mumbai

The great mimick again…Here the authors present a stunning image of TB …this time as a cause of back pain in pregnancy.

Seema Biswas
Editor-in-Chief

Spinal tuberculoma in pregnancy: a rare cause of back pain

We learn as medical students to include TB in the differential diagnosis of virtually all conditions. In the current state of global health where reducing the global incidence of TB by 50% by 2015 is a millennium development goal, this report in our images in section illustrates, in spectacular fashion, this great mimicker of disease.

Seema Biswas
Editor-in-Chief

Mycobacterium TB: sometimes, a hidden culprit

A 16 year old Egyptian girl presents with shortness of breath and fatigue and is found to be anaemic. She has lost 23kg over a year. A story of multi-system disease unfolds…

Seema Biswas
Editor-in-Chief

Tuberculous pericarditis associated with hoarseness of voice due to left recurrent laryngeal nerve paralysis

After pneumonia, diarrhoea is the most common cause of mortality in children under five years of age worldwide. Here the authors present a case of rotavirus gastroenteritis resulting in systemic complications. Happily, this infant makes a full recovery.

Seema Biswas
Editor-in-Chief

Global Health: A 10-month-old with rotavirus gastroenteritis, seizures, anasarca and systemic inflammatory response syndrome and complete recovery

The differential diagnoses for headache is endless… Here is a case from Iran of an 18 year old woman with tapeworm infestation. The pictures are remarkable.

Seema Biswas
Editor-in-Chief

Primary brain hydatosis