Exit Diagnosis

Dwayne Tarlov came to see me today for pain in his right wrist and left ankle for the past month and a half.

There hadn’t been much swelling, and he had no morning stiffness to suggest rheumatism. He had not had any fever or cold symptoms, and he absolutely denied any injury or new activities that might have brought on his symptoms.

His exam revealed his usual habitus, a slender, fine-boned fifty five year old man with gray hair, a tightly cropped beard and a new stud earring in his left ear.

His right wrist had normal range of movement, but localized swelling and tenderness near the extensor tendons of his thumb. There was no clicking or catching with thumb movements and I felt no crepitations.

The ankle was puffy on the outer, lateral, side and Dwayne was a little tender. Turning his ankle outward was painful.

I ordered X-rays, prescribed ibuprofen and recommended a wrist splint. We agreed to see how he is doing in two weeks. I asked again, and Dwayne could not remember anything he could have done to cause his pains.

I went back to my office to check messages and touch base with Autumn. A few moments later I was startled by a loud motor exhaust. Looking out the window, I saw Dwayne on a large Harley-Davidson motorcycle. His right wrist revved the gas, he squeezed the clutch and with his left foot, he kicked the bike into gear and roared off across the parking lot.

I typed an addendum to his office note to remind me about my exit diagnosis of his wrist and ankle pain.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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