"Not eating"

Like many places including the US, someone always knows someone who knew of someone that had symptoms similar to what they are currently experiencing---and then turned up dead. Not unlike when a random test (read PSA) finds the odd cancer and soon everyone wants to buy a PSA, regardless if it has a ounce of evidence to support the idea.

We saw a gentleman in Lobatse who presented several months ago for "snoring". He was apparently wondering if this was a "problem". Well the MO at the clinic decided to 1) try a course of antibiotics that just made things worse as they selected for a resistant strain of staph (yes we have it here although thankfully very rare), 2) got a sinus series from a machine and tech that are really old and very new respectively. The films were unreadable. By now the MO was really feeling pressure to "solve" this and ordered a 3) chest X-ray.

Now I spend a fair amount of time explaining to the MO's whom I mentor that one shouldn't go on a fishing trip unless one knows what to do when one actually catches a fish, i.e. don't get a test unless you know what you'll do with the answer. A negative test doesn't necessarily rule out anything or for that matter rule something in. So low and behold the CXR came back with a large "mass" in the area between the lobes of the left lung. He has undoubtedly had this for quite a while and of course is totally fixated on it. Not unfamiliar to those of us in primary care. What to do?

So the initial, trivial complaint is lost and were pursuing not a horse but a zebra! Happens everywhere.