Think Like a Doctor: More Than Meets the Eye By LISA SANDERS, M.D. | May 3, 2012,
http://well.blogs.nytimes.com/2012/05/03/think-like-a-doctor-more-than-meets-the-eye/
The Presenting Problem:
A middle-aged woman with newly diagnosed diabetes is referred to a specialist eye doctor after her own ophthalmologist notes an abnormality on exam.
[I’m presenting a case in which the diagnosis was made based on very little information. I’ll share everything that the doctor involved had to work with, but I warn you, it’s a tough one. As usual, the first reader to figure out this puzzle gets a signed copy of my book “Every Patient Tells a Story.”
http://www.amazon.com/Every-Patient-Tells-Story-Sanders/dp/0767922468
...
He was certain that she didn’t have the most common eye problem associated with diabetes: the development of abnormal blood vessels that can leak and diminish vision. But he thought that one of the nerves entering the back of the eye from the brain appeared thicker than normal, as if it was swollen. That was consistent with one of the more unusual but well-known complications of diabetes, a condition called diabetic papillopathy. [article has images patient’s retinas]
...
Once her eye doctor told her about his concern, she was more than willing to follow up with a subspecialist. And so she was referred to Dr. Robert Lesser, a neuro-ophthalmologist. . .
The Doctor’s Exam:
When she finished stating her medical history, she was taken to Dr. Lesser’s exam room. She waited only a few minutes before he came in. He was a trim man, tidy of dress with a youthful face, his hair streaked with white.
After the pleasantries, the doctor looked at her closely and asked her a question that no one had ever asked her before. That question ultimately led to a diagnosis with a disease she had never heard of or suspected, since she didn’t feel sick.
The Presenting Problem:
A middle-aged woman with newly diagnosed diabetes is referred to a specialist eye doctor after her own ophthalmologist notes an abnormality on exam.
[I’m presenting a case in which the diagnosis was made based on very little information. I’ll share everything that the doctor involved had to work with, but I warn you, it’s a tough one. As usual, the first reader to figure out this puzzle gets a signed copy of my book “Every Patient Tells a Story.”
http://www.amazon.com/Every-Patient-Tells-Story-Sanders/dp/0767922468
...
He was certain that she didn’t have the most common eye problem associated with diabetes: the development of abnormal blood vessels that can leak and diminish vision. But he thought that one of the nerves entering the back of the eye from the brain appeared thicker than normal, as if it was swollen. That was consistent with one of the more unusual but well-known complications of diabetes, a condition called diabetic papillopathy. [article has images patient’s retinas]
...
Once her eye doctor told her about his concern, she was more than willing to follow up with a subspecialist. And so she was referred to Dr. Robert Lesser, a neuro-ophthalmologist. . .
The Doctor’s Exam:
When she finished stating her medical history, she was taken to Dr. Lesser’s exam room. She waited only a few minutes before he came in. He was a trim man, tidy of dress with a youthful face, his hair streaked with white.
After the pleasantries, the doctor looked at her closely and asked her a question that no one had ever asked her before. That question ultimately led to a diagnosis with a disease she had never heard of or suspected, since she didn’t feel sick.