Mr. K is a 63 year old with severe emphysema.
He has had multiple hospital admissions over the last ten years for this diagnosis and has been followed in an outpatient clinic as well for the same length of time.
I recently met him for the first time.
When I shook his hand I noticed his 3rd through 5th fingers were in a sustained flexed position; he was unable to extend them.
We reviewed his history in detail.
Finally, I said, "I noticed the trouble you're having with your hand. When did it start?"
Mr. K.: The fingers started curling about 9 years ago and for the last seven I haven't been able to straighten them out.
Me: Have you had any one evaluate them?
Mr. K.: 5 years ago a Doctor said he thought I had arthritis.
Me. Any X-rays?
Mr. K.: No.
When I got back to the office I looked through all his old records. Over the last ten years, there was no mention of his right hand.
He came in for an x-ray that showed ulnar deviations, joint erosion's and subluxation at the MCP joints of the involved fingers.
Labs returned consistent with rheumatoid arthritis.
I'm glad I shook his hand.
It's another example of how we sometimes lose site of the trees (other medical diagnoses) in the midst of the forest (his most significant medical problem-his emphysema).