Anthony Papagiannis
Thessaloniki, Greece

Several years ago, I had a neighbor in his eighties who was also my patient. Whenever the need arose I would visit him at home after office hours, and we would have an informal chat as his children were friends of mine from our school years. One evening, he asked me to go and see him. As soon as he opened the door, he said: “Doctor, I want to get a new identity card.” I pointed out that there had been no change in his personal circumstances to necessitate such a move, whereupon he said with a twinkle in his eye: “Doctor, I would like to alter my date of birth. This is the root of all my health problems.”

Recently, I recalled this episode when a lady consulted me for the first time. For some months she had been feeling that her breathing was not quite satisfactory. She had no other symptoms, and she had already visited a colleague who had done some investigations. She had a clear chest film, but her spirometry six months earlier had been decreased, with lung volumes and capacities around 70 percent of the predicted values for her age and build. She had tried an inhaler, which did not agree with her, and she had soon abandoned it. There had been no progression in her dyspnea, and she was not particularly hampered by it, but she wanted a second opinion. The rest of her medical history was unremarkable, and physical examination and pulse oximetry were entirely normal.

“Let’s check your lung function again,” I said, and started to enter her data into the spirometry software. Rather than asking for her date of birth I glanced at the printout of her previous test: “6/6/1968,” it read. All of a sudden the cause of the decreased lung function was quite obvious. “What is your birthdate?” I asked. “June 6, 1943,” was the prompt answer. I typed it in, and performed the spirometry, with results identical to the first test in absolute numbers. However, there was one crucial difference: reference values vary considerably between the ages of 55 and 80 years. Thus the same forced vital capacity of 2.6 liters corresponded to 73 percent predicted when the year of birth was wrongly entered as 1968 but shot up to 103 percent predicted when the year was corrected to 1943. The same was true for all the other respiratory parameters. I explained this to the elderly lady and her son, who were much relieved to know that everything was normal.

There are rare occasions when patients are mistakenly given somebody else’s test results, and we should do well to ascertain that the images or reports that we are shown actually belong to the right person. My recent experience suggests that we should pay equal attention to the date of birth, that unique personal piece of data that may be the root of a patient’s health problems, real or occasionally factitious.