Sometimes, an otherwise complicated diagnosis can be made with a simple observation, without requiring many procedures or expensive tests.  Witness the case of Benji:

One day, a neighbor frantically knocked on my door and told me that she could not arouse her 6 year-old son, Benji.  I raced over to the house to find Benji lying on the couch, and indeed it did not seem possible to awaken him.  A preliminary neurologic exam revealed nothing wrong.  I then raised Benji’s arm above his face and let go.  Now, when a person is really unconscious the arm will hit his face.  However, if he is faking, the arm misses, since the patient does not want to hurt himself.  Benji’s hand missed.

Romance on the surgical service

I then announced to Benji, that since I could not wake him up, I would have to give him a big shot in the behind with a needle that he would not feel since he was not awake, and that I was going out of the room to prepare the shot.  I left the room with Benji’s parents and came back about a minute later.  Benji was gone.  He was hiding behind the couch.

So arriving at a complex diagnosis is not always difficult when there is a pearl that shows the way.

The Goldberg Files

The Goldberg Files is based on the struggles of Dr. Goldberg as well as those of his many students which he observed while teaching medical school for 25 years. This extensive blog is dedicated to assisting students in dealing with the stresses of medical education. Want to learn more?

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