Melnick A. How Doctors Think. J Am Osteopath Assoc 2009;109(8):464-465. doi: 10.7556/jaoa.2009.109.8.464.
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Clearly, I missed it [the ranger's unstable angina]... And why did I miss it? I didn't miss it because of any egregious behavior or negligence. I missed it because my thinking was overinfluenced by how healthy this man looked... Happily, he didn't die.
The unstable angina didn't show on the [electrocardiogram], because fifty percent of such cases don't... His unstable angina did not show up on the cardiac enzymes because there wasn't yet injury to the heart muscle, and it didn't show up on the chest x-ray because the heart had not yet begun to fail to pump blood, so there was no fluid backup into the lungs.
JudyAnn Bigby is a compact woman with a round face, alert eyes, and a lilting, almost musical voice that often breaks into laughter. She was raised in Hempstead, Long Island. When she was a child, hers was one of the first African-American families in town... Her father worked as a mechanic for United Airlines and only later in life did her mother, a homemaker, return for a high school equivalency degree.
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