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June 28, 1985

Difficult Diagnosis

Author Affiliations

Hines Veterans Administration Hospital Chicago


by Robert B. Taylor, 598 pp, with illus, $49, Philadelphia, WB Saunders Co, 1985.

JAMA. 1985;253(24):3609. doi:10.1001/jama.1985.03350480119040

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


A number of academic physicians from various specialties collaborated in the diagnostic approach to 68 of the most enigmatic clinical presentations that have puzzled the editor, a professor and chairman of family practice. These are arranged in alphabetical order from "Abdominal Pain, Acute" through, among others, "Breast Discharge," "Diarrhea, Chronic," "Failure to Thrive, Infant," "Hyperkalemia and Hypokalemia," "Impotence," "Jaundice," "Pulmonary Nodule, Solitary," "Tinnitus," "Urinary Incontinence," and "Vertigo" to "Weight Loss." Experts in particular fields have thoughtfully considered each topic. They have stressed "high payoff" questions on the medical history, key clues from the physical examination, and some useful branching algorithms. Many useful tables are present.

As an example, "Calf Pain" may be the only sign of a potentially serious venous thrombosis, but in most clinical settings it is explained by one of 17 other mostly benign conditions. Which instances call for the "big guns" and which can be simply dismissed?