Clinical problem-solving: Diverted by the chief complaint

To the Editor: The Clinical Problem-Solving article entitled “Diverted by the Chief Complaint” (July 6 issue)¹ deserves the name “Diverted by Our Major Mistake.” It is amazing that a pathology report of a liver biopsy and not the distended jugular veins of the patient led to the correct diagnosis of constrictive pericarditis. The excuses of the authors (“it is not surprising that the correct diagnosis was overlooked initially,” “it is hard to fault the physicians,” and “clinicians often overlook elevated venous pressures”) are unacceptable: detection of engorged cervical veins is within the competence of medical students and should not be.