Most medical diagnoses are obvious if you ask the right questions. However, some are less obvious. In those instances, it is important to make sure that all the information is obtained. That is usually obtained through asking more questions.

But it is dependent upon asking the right questions. It is also dependent on getting the right answers. There are times when a complex diagnosis can hinge on one minor piece of information.

When I was assigned to Andrews AFB in the early 1980s, we had a six-week-old patient come to the medical center for surgery. He had a condition called pyloric stenosis that was common at that age. The surgery is pretty routine.

After the surgery, I got a call at 2 a.m. from one of the interns. He told me that the patient was coding. When I got to the hospital, the infant was receiving CPR. I noticed that the abdomen seemed distended. So I got a needle and tapped it. Blood came out. The abdomen was filled with blood, so there was clearly a bleeding problem. We continued CPR and started IV fluids.

We called the parents and went in to talk to them. We explained that the patient was bleeding and we did not know why. As the intern and I walked out the door, the mother said: “Does it mean anything that there is a family history of hemophilia?”

We stopped in our tracks. How could that not have come up before? What the parents did not know is that hemophilia is only inherited through the mother. This woman had an uncle with hemophilia. Her grandmother had the uncle with her first husband. She had the patient’s mother and two sisters with her second husband. The family assumed that it was the first husband who was the carrier.

They assumed incorrectly. So when the intern on admission asked if there was any family history of diseases, they said no. We asked the right question but did not get the right answer. Unfortunately, it was too late to save the patient.

I had another patient here in Seaford who came to see me for an ADHD workup. I did the usual history. I do not usually ask a question about which class has the worst ADHD symptoms. However, the mother volunteered that information on her own. She told me that the ADHD was worst in gym class.

That made no sense to me. She explained that in gym class they ran around the track. The girl would stop in the middle and block everyone on the track. That made no sense for a diagnosis of ADHD. However, it did make sense from another standpoint. I took her into the exam room and had her hyperventilate. In the middle of it, she stopped and had a staring spell seizure.

She did not have ADHD. She had seizures. This time I did not ask the right question. However, the mother offered the right answer even though it was unsolicited.

The third case involves an adolescent patient who was found by her brother after a breakup with her boyfriend. He came home to find her awake but not responding. The family were concerned about the psychological trauma. We found the same unresponsiveness on exam.

I went through an exercise with the interns about what other conditions could possibly create this appearance if the family was wrong. The intern on the case decided to look at other conditions. He did an EEG. The EEG showed that she was having a seizure and it was medical and not psychological.

In this case, there was not information that was asked for or offered. It was more related to good medical practice which meant ignoring the story as given and looking deeper.

Some things are not always as they seem. Sometimes, you have to seek an alternate path. You never know when the right information is going to show up.

Testosterone levels- Pete Hegseth had to abandon his “voluntary” flu vaccine program because of a flu epidemic. Now he wants to test troops over 30 years of age for testosterone levels. He will then offer supplements if their testosterone is low. That will open the door for a bunch of unwanted side effects. Administrators should not practice medicine.