In health care we talk about common vs uncommon conditions like this:
If you hear hoof-beats, it is more likely to be a horse (common issues) than a zebra (uncommon).
Sometimes we forget that our patients travel to places where there are a lot of zebras.
My wife was a nurse who some years ago had a patient who had traveled to Africa and was bitten by his own dog he brought with him, which had been bitten by some other animal. He contracted rabies, and by the time it was diagnosed after he returned home, it was too late.
Like you said...hoof-beats.
The symptoms are difficult to diagnose from, but once it takes hold, there isn’t much help for you. I am not surprised it was missed. Apparently, being nipped by his dog wasn’t even foremost in his mind.
JMHO, but there is no intellectual curiosity in medicine anymore. If a woman, especially if you’re a woman, and present with anything from increased heart rate to breathless feeling, it’s likely to be diagnosed as a panic attack.
This woman returned several times to the ER and each time was turned away with the an “easy” diagnosis. I’m not a Dr. but correct me if I’m wrong. If blood tests were run, and rabies is an infection, wouldn’t she have had an elevated white blood count?
“Sometimes we forget that our patients travel to places where there are a lot of zebras.”
So true. When I practiced in Alaska rabies was always in the back of my mind due to the high percentage of wild and domestic canids that were infected. When I lived in SE Idaho I had a patient who may/may not have been scratched on her scalp by a bat. Fortunately she had the bat and it tested negative but not before treatment had been started.
I once encountered a patient in Alaska with flu-like symptoms in May. When I entered the room his neck was swollen up so much it was wider than his head. That was weird. One of his white blood cell counts was extremely elevated. I researched this in a pathology book (which is a clue to how long ago this happened!). I suspected trichinosis. I asked him if he had eaten any undercooked pork or bear meat recently. Yep, he had eaten some undercooked grizzly bear steaks from last Fall while he and his buddy were out Spring bear hunting. You know - eat bear, hunt bear! He damn-near died and had life changing disabilities after he recovered.
So yeah, its often horses but sometimes there are zebras around. Its vital to understand not only the environment where you practice but what kinds of other environments your patients might visit. Like the Eskimo family who developed trichinosis from eating fermented walrus flipper...
I don't know how. Every time I see a medico, any medico, I'm asked if I've been out of the country lately.