Missing Elements of the History

A 59-year-old woman with a history of bilateral total hip replacements and a total knee replacement sees her physician for cough, exertional dyspnea, and foot swelling that had developed 2 weeks earlier while she was on vacation in Europe. ForewordIn this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.StageA 59-year-old woman presented to her primary care physician with cough, exertional dyspnea, and foot swelling that had developed 2 weeks earlier while she was vacationing in Denmark. She had no rhinorrhea, pharyngitis, fever, rash, diarrhea, or new joint symptoms. Her medical history was notable for polyarthritis, for which her rheumatologist prescribed minocycline and meloxicam. She had undergone right total hip replacement 4 years previously, left total hip replacement 3 years previously, and left total knee replacement 1 year previously. There was no history of hypertension or diabetes. She had never used tobacco, illicit drugs, or herbal supplements and ...