Martin’s mistaken and missed diagnoses

ME is a great diagnostician and recognizes esoteric syndromes fairly frequently, and we generally come away with the notion that his diagnostic skills are exceptionally good. Nonetheless, sometimes he gets a diagnosis wrong or misses it entirely. No doctor can diagnose everything correctly, but he is loathe to admit a mistake of any kind. In this he is not all that different from most doctors in general who can sometimes go off in the wrong direction and even have blinders on when it comes to certain medical conditions. When ME gets a diagnosis wrong, though, he blusters and blames others rather then accept his mistakes. Let’s see how many of the mistaken diagnoses I can come up with:

Water contamination source, not pool and not the village water service but Bert’s bottled water. Later his dishwasher is the cause of stomach problems in the village. There are contaminants due to his having hooked up the dishwasher incorrectly, but he blames the young substitute receptionist for serving tea to his patients.

Peter Cronk’s injury following fall. He dismisses Peter’s abdominal discomfort and Louisa’s concern as overreacting. When it turns out that Peter becomes very ill and Louisa calls him in the middle of the night to come to the Cronk house, he realizes Peter’s spleen has probably ruptured. This time he starts to apologize but gets cut off by police arriving.

Danny Steel’s mother’s dementia turns out to be dehydration. At first ME suspects nothing wrong and figures Danny is overreacting just to place his mother in a home. Once she’s in the home, he notices that she hasn’t been taking her medicine and that she resists drinking fluids at night.

The students at school come down with what looks like impetigo to ME and he wants them all to stay home because it’s very contagious. It turns out to be erysipelas instead, which is not contagious.

Old man (Mr. Cook?) with stench doesn’t have a hygiene or health problem, he has a dead bird in his bag. (Surprising that Martin doesn’t check the bag that the man carries with him at all times.)

Caroline doesn’t have a drinking problem, she has diabetes; Dennis doesn’t have a drinking problem, he has Parkinson’s. Both of them slur their words and have trouble driving properly, but the suspicion that they have been drinking to excess is wrong. ME treats them properly once he knows what the problem is, but never apologizes for assuming they were over-imbibing.

Phil Pratt’s wife Helen. She’s much sicker than he suspects and he doesn’t notice her labored breathing, her diaphoresis (or perspiring), or weakness because he’s irate that he’s had to make a housecall and he’s irritated about Louisa’s relationship with Danny. Helen dies while he’s calling an ambulance and he compounds his rather restrained reaction to her condition by having very little compassion for her husband. When Joan arrives and tries to smooth things over, M still shows no sympathy.

Mrs. T’s neck and her need to use a cervical collar. When she takes it off, it turns out she has a prolapsed disk problem. He also misses her Erotomania and falsely accuses Louisa of having it.

Delph, Allison’s daughter acts out of control, but ME just thinks she’s naughty. Finally, after Delph takes a nasty fall through the glass door of a shop, ME realizes there’s something very real wrong with her. It turns out she’s really hyper due to diet pills.

Mrs. Selkirk is mourning the loss of her husband and hallucinates that he’s talking to her. ME assumes her hallucinations are due to grieving, but later discovers she has Lyme disease and that accounts for her symptoms.

At one point, ME examines a man for testicular problems. This mistake is due to examining the wrong patient because he’s been given the wrong notes. Even though it’s Pauline’s mistake, he should have checked the name.

Al has gone to Uganda and had a terrible trip. He can’t seem to shake the fatigue and difficulty getting back to a normal routine. He talks to ME about it but ME considers his symptoms inconsequential. Then Al faints and ME discovers he’s been bitten by a tsetse fly and probably gotten East African sleeping sickness.

Woman has swollen ankles and dark complexion with joint aches. ME thinks she’s been spending too much time outside, but it turns out she has too much iron in her system.

Mr. Moysey is having a variety of symptoms including dizziness. When he comes to the surgery to get his prescription refilled, he has a bloody nose. He gets his prescription although ME does a cursory exam. He returns after having more symptoms but ME still isn’t concerned. Ultimately Mr. Moysey falls in his home and Ruth calls Martin. Now he finds skin lesions when he opens Mr. M’s shirt and realizes he has scurvy from following a diet low in nutrition since his wife died.

Malcolm, a hypochondriac, complains of skin problems and seems to be breathing poorly. ME suspects possible asbestosis, although because Malcolm is a hypochondriac it’s easy to dismiss his complaints. Asbestos poisoning is eventually ruled out and, when Malcolm uncharacteristically misses an appointment, Morwenna finds him blacked out in his yard. It turns out that Malcolm keeps pigeons, which everyone except ME seems to know about, and he has gotten pigeon fancier’s lung from the fecal matter.

Then, in the last episode, ME vaccinates a woman for rabies, although she complains of headaches. We might forgive him for being distracted and not paying proper attention to her since Louisa is getting ready to leave; however, when he realizes his mistake, he is not apologetic. He tells her she should be all right and may experience some nausea and other symptoms. But she should be fine. She finds this poor consolation.

If I’ve missed any other examples, I’m counting on anyone reading this to help me out. I wanted to review these mistakes because it’s so easy to merely think of ME as a “wonderful doctor” and forget the times when he goes awry. I’m glad these examples are included because it keeps things much more real. Luckily, most of the patients end up doing well after these missed diagnoses, with the notable exception of Helen Pratt. (Truth be told, Martin probably would not have been able to save her even if he had tried to do something. Still, trying would have meant something to Phil.) It would be nice to think that happens in the real world too. In addition, ME clearly hates to be wrong and has a problem admitting when he’s wrong. Showing sympathy is also hard for him. Most of the time his lack of sympathy is funny. On the other hand, when there is evidence of honest sympathy, it has more significance. This is true for the times when he admits that he’s been wrong as well.

Originally posted 2014-03-13 20:42:24.

13 thoughts on “Martin’s mistaken and missed diagnoses

  1. Carol

    Delph was also hyped up on stolen Ritalin.

    This post is interesting because I hadn’t realized how many things he had missed. I do not usually “get” it before Martin, but even I got Caroline’s diabetes before he did. That was pretty obvious what with the mood swings, weight loss and thirst. Oh well, nobody’s perfect, right?

    🙂

  2. kjacobson@mindspring.com Post author

    You’re absolutely right about Delph. The Ritalin was very much to blame for worsening her behavior. I also came up with Caroline’s diabetes, but M didn’t know about all of her symptoms as early as we did. It still took him surprisingly long to think of that considering how prevalent diabetes is.

    I also thought about another case-the couple who were using extreme sex tools and the husband had a long list of injuries. M should have suspected some foul play before visiting their home, I think.

    We clearly know that M is not perfect for many reasons and missing diagnoses is one that probably would bother him a lot. So having trouble admitting when he makes these mistakes and being uncomfortable apologizing are traits that stand out under these circumstances. Then when he behaves that way with Louisa, it’s not unexpected. And when he finally can take responsibility for being wrong, it’s that much more meaningful.

  3. kjacobson@mindspring.com Post author

    Do you mean medical ones? He tells L he was wrong when she’s about to give birth and he says he was an idiot when he’s talking to Mrs. T at the “castle.” He also apologizes to the singer in the last episode for not giving him a proper exam. But, I don’t think he admits his mistakes when it’s something medical. He comes close with the erysipelas.

  4. kjacobson@mindspring.com Post author

    I just remembered that he also tells Mrs. T that she was right to wear the collar. He shows some sympathy toward the young woman who wants to take something to get bigger breasts, and some toward Roger Fenn when he visits him in the hospital. He is most likely to show the softer side of himself when he’s with Louisa though.

  5. Linda

    I was just watching S6E8 again and was confused by the operation. On the plane, she was complaining of an unusual pain on the left side of her head and I thought Martin had called a left side venous malformation when he called for an operating room. Why then, was he doing things on her right side during the operation? Is that what happens in brain surgery? Did this confuse others?

  6. Maria

    Yes, the AVM and her headache were definitely on the left side. I think I read somewhere that he inserts the catheter into the carotid artery on the right side because of her broken collarbone on the left.

  7. kjacobson@mindspring.com Post author

    The scene is definitely another case of relative inaccuracy regarding medical procedure. As I said when reviewing this episode in my post “Medical Questions Related to S6E8,” it’s rare that they would use the carotid artery at all. Now the femoral artery in the groin area would be the most likely point of entry for an embolization of an AVM. But they want M in the area of her head, of course. I think Maria’s explanation is as good as we can get within the context of the scene. I also wonder if we’ll see further complications from this procedure because embolizations are often followed by surgery. Stay tuned…

  8. Maria

    Oh my gosh, another surgery would really be something. Karen said in an earlier post that Louisa is a superwoman – I have to agree; she has had a broken collarbone, deep vein thrombosis, and AVM embolization within the space of three days (or maybe only two?)!

    I think it would be interesting to see a situation in which Martin is sick and Louisa takes care of him. Not something serious, just something acute and flu-like that lays him low for a couple of days and has her hovering, making tea and toast, that kind of thing. It would be a nice opportunity to display her nurturing side and see how he responds to it.

  9. kjacobson@mindspring.com Post author

    I like your idea of turning the tables and Louisa taking care of Martin, although she needs to recover first. Of course, we could start off after she has recovered. I really think we haven’t seen enough expression of love from Louisa yet, which could also be a reason why Martin is still a bit unsure of her love for him.

  10. James Regan

    Perhaps I am little off base with this reply, but it seems that Martin wasn’t a general practitioner until he came to Portween. I suspect the medical training is pretty much same, but the focus of a surgeon seems entirely different to me. The comment “all surgeons can be a general practitioner, but all general practitioners can not be surgeons.” speaks directly to the obvious fact that different cognitive skills are involved.

    That said, I suspect it was a tough transition for Martin to become a GP. Louisa picks up on it right away in the first episode, and I believe his lack of GP experience had some effect on his ability to diagnose patients correctly. However, Martin appears to be at his best when he is dealing with a life-threatening situation. Many of them are heartfelt moments for Louisa and me;-).

    Putting the blood fear aside for the moment, I believe Martin’s issue of not being a surgeon anymore has never been adequately addressed, and this issue very likely enters into the arena of Martin’s and Louisa’s on-and-off again relationship. I also suspect his inability to admit that he is wrong about medical diagnosing just comes with the territory. Yes, surgeons make mistakes, but from the surgeon’s perspective, there appears to be much less tolerance (internally and externally) for admitting that you are wrong. Perhaps, Martin working on his clocks is probably providing him with some good therapeutic value. It may have been one of the reasons he became interested in becoming a surgeon. Perhaps this would be a rich area of discovery for a therapist to explore.

    If interested, you might want to watch a show called Monroe with James Nesbitt. It only lasted for only two seasons, but I found it to provide a fascinating glimpse into what it must be like to be a neurosurgeon.

  11. kjacobson@mindspring.com Post author

    James I think my husband, who is a neurologist and does not do surgery, would say that those who choose to be surgeons generally have a different personality type from those who choose to be diagnosticians. Every specialty attracts different personality types. So I would agree that it would be tough for a surgeon to transition to being a GP. My initial reason for writing about the missed diagnoses, and mistaken ones, was more about how even someone who is portrayed as being so astute when it comes to a whole host of rare disorders/diseases makes mistakes. Throughout this show ME’s ability to function as a GP is quite extraordinary considering the disparities between being a surgeon and a GP. He seems to have taken the switch from one specialty to the other in stride. The biggest difference between the two specialties is that surgeons do not typically build relationships with their patients to the extent that GPs would. In ME’s case, he was forced to leave surgery due to his sudden realization that he was treating a person and not just a case. In Portwenn he is not inclined to treat his patients with much personal attention in his clinic, but he goes to great lengths at times to get to their homes or rush to their sides almost anywhere they could be. He may be brusque and yell at them, yet he is always on call and suspends anything else he’s doing when there’s a medical emergency, even to the point of absurdity. Of course, that’s part of the humor of the show too.

    As a surgeon he would find it hard to admit making mistakes because there is little room for mistakes in surgery, and that is exactly what we see on this show. I have at times thought about writing a post on how much surgery ME actually still performs while practicing as a GP. He stitches up all sorts of wounds and even operates on Louisa’s mother’s hernia in his office. I find that somewhat odd because of his blood phobia and the strong reaction he had to continuing to operate in London. They had to come up with a reason for him to move to Portwenn, and saddling him with a blood phobia is ironic and humorous, but now he manages to operate fairly consistently without too much trouble. That seems to be another way they are being ironic. He really hasn’t left surgery.

    Your mention of the clocks as a therapy brings up the fact that they eliminated them entirely from S7. His hobby of fixing clocks is nowhere in evidence in this last series and is never mentioned to the therapist. I have no idea why.

    Thanks for the heads up in regard to the show about a neurosurgeon. I’ll try to check it out.

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