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May 9, 1977

Quality of Medical Care

JAMA. 1977;237(19):2036-2037. doi:10.1001/jama.1977.03270460022008

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To the Editor.—  The special communication by Dr W. E. Mitchell entitled "How to Deal With Poor Medical Care" (236:2875, 1976) describes two examples of poor medical care. Dr A performs too many unnecessary appendectomies. Dr B performs unrecognized or inappropriate procedures.The diagnosis of acute appendicitis is sometimes difficult to make because many other conditions can mimic it. Frequently, a patient with all the signs and symptoms of appendicitis will have a normal appendix with perhaps a few enlarged mesenteric lymph nodes. Again, the appendix may be normal, but a foreign body (such as a toothpick) may have perforated the cecum. Patients are usually referred for surgery by a well-qualified physician. It takes a brave man to dispute the diagnosis. Dr A may have missed the diagnosis and not operated, only to see peritonitis develop, with its morbidity and sometimes mortality.Dr B, who probably continues to use obsolete