Anthony Papagiannis
Thessaloniki, Greece

The weekly grand rounds was the central educational event at the big teaching hospital. Everybody who could get away from clinical duties, regardless of specialty, attended the Tuesday lunchtime event at which we aspired to present our interesting or puzzling patients, or earn brownie points by hitting the obscure diagnosis that had eluded another colleague. I remember my mischievous delight as an infectious disease consultant almost froze in his tracks with his jaw visibly dropping when I offered ‘Factitious fever’ as the first answer to a long and mysterious febrile illness he had taken pains to describe in detail. His thunder had been stolen by a junior. ‘Yes, it was all self-induced,’ he admitted, ‘but how did you guess?’ I was not all that clever: I happened to have read about a similar case in the venerable Case Records series of The New England Journal of Medicine,¹ and I said so.

It was an unwritten convention that junior doctors could ask questions and have a shot at diagnosis before the specialists were invited to comment, and it would have been bad form to do otherwise. But some people liked to take their chances. Such was the case of a consultant geriatrician who, on listening to a patient presentation, promptly and smugly commented loudly: ‘Well, as the case was presented by a chest physician, and as I see in the first row a nephrologist and an otolaryngologist, the patient must have Wegener’s granulomatosis’. Traditional respect for medical hierarchy prevented those present from heckling. However, the buzz of disapproval around the large auditorium was quite audible, and I am sure he got the message.

Reference

1. Jacoby GA, Hislop NE. Intermittent polymicrobial bacteremia and fever (Case 35-1979). N Engle J Med 1979; 301: 488-496.