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Eugene J. Kraemer, M.T., D.C.
Glendale, California
In answer to Dr. Kraemer's comments concerning my article "The
Diagnosis Was Correct But the Patient Died," he states the
following:
- Dr. Dishman stated that a shift to the right (High Polys)
suggested to be acute bacterial rather than viral type infection.
I am disagreeing with him. A shift to the right is an increase in
polys as stated, but the poly must have more than seven nuclei. This
condition is found in P.A.
- The hemophilus bacilli is not gram positive rod, but a gram
negative one.
My responses are:
- I do not pretend to practice medical case management. The
details of the medical diagnosis were anecdotal and I reported what
I was told.
- The article was written more as a metaphor to illustrate and
emphasize one central idea which was stated by Maimanoides (or was it
Osler, but who cares), "Let the patient be the doctors' books." If
physicians will really listen to the patients with all their senses,
the patient will usually give them the diagnosis.
- The article was not an exercise in the criteria for differential
diagnosis. I am not sure whether Dr. Kraemer is correct that a
shift to the right restricted to P.A., although I am told that
Hemophilus bacilli is indeed gram negative. Also, the antibiotic
mentioned in the article, I am told, is only orally administered,
not intravenous (Ceftin). It is gratifying to know that some DCs
and MDs read my articles and care enough to want top quality
reporting. I apologize for the errors.
Robert W. Dishman, M.A., D.C.
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